Medicare requirements for Wheelchair – Medicare Wheelchair

If you have a Medicare part B [Medical Insurance] it will cover wheelchairs also [Scooters] Power-Operated Vehicles called as (DME) – Durable medical equipment, Which you are doctor may prescribe to use in you are Home.

What are the Requirements for Medicare Wheelchair?

Here are some requirements you need to follow if you’re willing to get Medicare Wheelchair as follows

  1. You must need to have face-to-face Examination
  2. You must submit a Written prescription from a doctor
  3. Submit other treating provider before Medicare Covers a Power Wheelchair or a Scooter.
  4. Medicare Part B Covers power Wheelchairs only when they are in need of medically necessary.

What is your Cost in Medicare Wheelchair?

Here Medicare Part B pays 80% of the cost of a Wheelchair, after annual deductible you will only need to pay 20% of the cost for wheelchair to your annual Medicare Premiums if your supplier accepts this assignment. Also Medicare pays for Different kinds of (Durable medical equipment) – DME way. Depending on which type of equipment is need:

  1. If you’re in need of renting the equipment.
  2. If you need to buy the equipment  and
  3. If you’re able to choose whether to rent equipment or to buy the equipment.

If you’re Doctors and Suppliers are enrolled in Medicare then Medicare will cover your (DME – Durable medical equipment) This Suppliers and Doctors need to meet strict standards to enroll and to stay enrolled in a Medicare.

Note – if you’re Doctors and Suppliers are not enrolled in DME Suppliers, then Medicare won’t pay for the claims which are submitted by the Doctors and Suppliers.

Always make sure that Doctors and DME Suppliers are enrolled in a Medicare. Ask your supplier if they participate in Medicare before you get into DME. If you’re suppliers are participating in a Medicare then they must accept assignment which means that they will only change you’re coinsurance and Medicare Part B Deductible from the Medicare approved amount.

Note – If you are Suppliers are not participating in Medicare DME and they will not accept assignment, then there is no limit on the amount that they going to charge you on DME.

Things to know about Medicare DME

Prior authorization – you may have to get a prior approval for some types of power wheelchairs before the Medicare covers the wheelchair cost.

Medicare Requirements for WheelChair

Here your DME Supplier should provide:

  1. Request of the “Prior authorization”
  2. The Supplier should send the request or required documents to the Medicare.

You don’t need to take a risk here, if your physician prescribes the wheelchairs to you. Then you’re DME Supplier will submit or request a Prior authorization Documentation to Medicare by your side, Now the Medicare will review the information which is submitted to make sure that you are eligible to the power Wheelchair coverage. Medicare coverage, benefits will be the same. And you will not get any delay in getting the items what you need.

Your application or you are “prior authorization” request may be denied if as follows:

  1. If Medicare finds you do not medically required a Power Wheelchair.
  2. If Medicare do not get enough information to make a decision

Note – If Medicare needs any other additional information, you are DME Supplier may resubmit you request (Prior unthorization request)

What are the types of Equipment?

Here are the equipment given my Medicare

  1. Manual wheelchair
  2. Power Operated vehicle or Scooter and
  3. Power Wheelchair

Manual Wheelchair

Those who can’t use a cane or Walker safely, but if you have good upper body strength or (if you have someone to help you out) you may easily qualify for a manual wheelchair, Firstly you have to rent a manual wheelchair before you go for a buy.

Power-operated Vehicle or Scooter

Those who cannot operate a manual wheelchair or if you cannot cane or walkers, then you are qualify for a power operated scooter. If you want to qualify for this power operated vehicle you need to get in and out of it safely and you need to be strong enough to sit up on and operate the controls.

If you don’t need this power operated vehicle for a long term, you may speak to you talk to you are supplier and take it on a rent, talk to you are supplier about this.

Power wheelchair

If you are unable to use your manual wheelchair at you are home, or if you do not qualify for a Power Operated scooter, you may now qualify for a power wheelchair,

Note – Before you get your power wheelchair or a scooter, you must have a face to face exam with you are doctor, the Doctor will see and review if you are in need of wheel chair or not, then the doctor will submit a order by writing telling to Medicare why you need the wheelchair and mention that your able to operate the wheelchair.

People also ask (FAQS)

What are the Medicare wheelchair Documentation requirements?

Documentation requirements for Medicare Wheelchair as follows:

  1. Standard written order which contains all of the following elements
    • Medicare Beneficiary Identifier (MBI)
    • Beneficiary’s Name
    • The General Description of the item
      • The description can be with a:
        • Wheelchair or hospital bed, HCPCS code, HCPCS code narrative or a brand name or Model number
    • For a equipment
    • Quantity to be dispensed if applicable
    • NPI or treating parctitioner name
    • Signature
    • Order Date

For More information on Documentation requirements you may visit

Medicare wheelchair evaluation form

Medicare Wheelchair evaluation seating or Mobility Evaluation, This form is to be completed by the Physiatrist or Physical/Occupational Therapist in Association with mobility Device Specialist.

Information need to fill:

  1. Name
  2. DOB
  3. sex
  4. Evaluation Date
  5. Address
  6. Physician
  7. Phone number etc

To Get your Medicare Wheelchair Evaluation Form you need to Download it form Here – Download Medicare Wheelchair evaluation Form

What are the Wheelchair Prescription Guidelines?

The Prescription Guidelines involves:

  1. Selecting the type and size of Wheelchair
  2. Describing any specific set up for the wwhelchair
  3. Selecting the wheelchair of what postural support the devices
  4. Modifications of the wheelchair according
  5. Additional postural support may need.
  6. Wheelchair user information
  7. size of a wheelchair available and size range

How often will Medicare pay for a Wheelchair?

There is no extra charge for you to pay for the Wheelchair repairs because rental agreement mention not to pay for repairs, also Medicare covers a Wheelchair or a Scooter replacement every once in a 5 years, Note – Medicare only pays or covers Wheelchair and Scooter repairs.

What Diagnosis Qualifies for a wheelchair?

There are a wide variety of diagnoses may potentially qualify for wheelchairs some of the common Diagnoses are:

  1. Alzheimer’s Disease
  2. ALS (Lou Gehrig’s Disease)
  3. Amyotrophic Lateral Sclerosis
  4. Anterior Horn Cell Disease
  5. CNS Demyelination
  6. Cerebellar Ataxia
  7. Cerebral Palsy
  8. Chronic Inflammatory Demyelinating Polyneuropathy
  9. Congenital Diplegia
  10. Congenital Skeletal Deformity
  11. Friedreich’s Ataxia
  12. Guillian Barre
  13. Hemiplegia
  14. Hereditary Spastic Paraplegia
  15. Huntington’s disease
  16. Myelopathy
  17. Multiple Sclerosis (MS)
  18. Muscular Dystrophy
  19. Myopathy, Congenital
  20. Osteogenesis Imperfecta
  21. Paraplegia
  22. Parkinson’s Disease
  23. Post-Polio Syndrome
  24. Progressive Muscular Atrophy
  25. Schilder’s Disease
  26. Spinal Cord Injuries
  27. Spinal Muscular Atrophy
  28. Spina Bifida
  29. Spinocerebellar Disease
  30. Transverse Myelitis
  31. Traumatic Brain Injury
  32. Werdnig-Hoffman’s Disease
  33. And many others

Does Medicare Cover Wheelchairs for Seniors?

Yes, The Wheelchairs covers for seniors who are unable to walkers, Medicare cover DME, The Doctor who is treating your condition submit a written documents or request to Medicare, That your in medical need for a wheelchair or a Scooter for your use at home. Then Medicare Provide you Wheelchairs as soon as possible.

Does Medicare Cover Power Wheelchairs?

Yes, Medicare will cover Power Wheelchairs or Scooter as a Durable medical equipment (DME) which is prescribed by your Doctor based on your medical condition.

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