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Prescription Requirements

All Power Mobility Devices require a written prescription prior to delivery.  The equipment supplier is required by Medicare to have the written prescription, plus proof you have considered the 9 questions listed under the examination requirements, in their files prior to delivering the Power Mobility Device.

The written prescription must contain the following:

  1. Beneficiary's name
  2. Description of item that is ordered.  This may be general – e.g. "power wheelchair"- or may be more detailed.
  3. Date of the face-to-face examination
  4. Pertinent diagnosis/conditions that relate to the need for the power mobility device
  5. Length of need
  6. Physician's signature
  7. Date of physician's signature

If all 9 questions are not supported by the medical record history and cannot be addressed through the face-to-face examination of the patient, you may refer the patient to a licensed/certified medical professional (LCMP) who has experience and training in mobility evaluations to perform part of the face-to-face examination. This individual may not be an employee of the supplier or have any financial relationship with the supplier. (Exception: If the supplier is owned by a hospital, an LCMP working in the inpatient or outpatient hospital setting may perform part of the face-to-face examination.)

The equipment supplier are required to prepare a written document, called a "Detailed Product Description", that lists the specific base (HCPCS code and manufacturer name/model) and all options and accessories that will be separately billed. The supplier must list their charge and the Medicare fee schedule allowance for each separately billed item. The physician must sign and date this detailed product description and the supplier must receive it prior to delivery of a power wheelchair or POV.

PMD Prescription: A sample prescription form that contains all the necessary elements that are required on a prescription per the interim Final Rule/Local Coverage Determination policy.

Medicare Physician Resource Guide: Provides guidance to physicians on the current coverage policy for PMDs, face-to-face exam requirements, PMD prescription requirements, and what to include in supporting documentation/informations.

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