- Medicare policy on mobility products requires that Medicare funds are only used to pay for:
• Mobility needs for daily activities within the home
• The lowest level of equipment required to accomplish these tasks.
• The most medically appropriate equipment that meets your needs, not your wants
- Medicare requires that your physician or healthcare provider and supplier evaluate your needs and expected use of the mobility product to determine which item you will qualify for.
- They determine which is the lowest level of equipment needed to help you be mobile within your home to accomplish daily activities by asking the following questions:
• Will a cane or crutches allow you to perform these activities in the home?
• If not, will a walker allow you to accomplish these activities in the home?
• If not, is there any type of manual wheelchair that will allow you to accomplish these activities in the home?
• If not, will a scooter allow you to accomplish these activities in the home?
• If not, will a power chair allow you to accomplish these activities in the home?
- Keep in mind that if you have another higher level product in mind that will allow you to do more beyond the confines of the home setting, you can discuss with your supplier the option to upgrade to a higher level or more comfortable product by paying an additional out of pocket fee using the Advance Beneficiary Notice (ABN).
- Your home must be evaluated to ensure that it will accommodate the use of any mobility product.
- A face-to-face examination with your physician or healthcare provider to specifically discuss your mobility limitations and need for mobility is required prior to the initial setup of a power chair, scooter or manual wheelchair.
- In some cases, such as for custom manual chairs and power mobility items, you may also be asked to see a physical therapist or occupational therapist to determine the best fit and equipment selection.
- The majority of all manual and power wheelchairs are considered capped rental items and that means they cannot be purchased outright. You will own the equipment after Medicare makes 13 payments toward the purchase of the equipment.
- Newly established requirements of the Affordable Care Act require a specific office visit with your physician or healthcare practitioner to assess and document your need for this equipment and they must then issue a compliant written order.
- Depending on which product is ordered, your supplier may not be able to deliver this equipment to you without a written order or certificate of medical necessity from your doctor or healthcare provider. If the equipment is subject to these special rules, your supplier cannot get the documentation at a later date because if they do, Medicare can never make payment for those products to you or your supplier when a compliant order is not secured before delivery. So please be patient with your supplier while they collect the required documentation from your physician or healthcare provider.
** Some or all of the products in this category may be subject to competitive bidding depending on where you live. Ask your supplier for details.