FAQs about Medicare and mobility products:

1. Medicare will pay for a motorized wheelchair, although it is not guaranteed that you will qualify or be reimbursed by Medicare.

A power wheelchair is covered when all of the following criteria are met:

• The patient's condition is such that without the use of a wheelchair the patient would otherwise be bed or chair confined.
• The patient's condition is such that a wheelchair is medically necessary and the patient is unable to operate a wheelchair manually.
• The patient is capable of safely operating the controls for the power wheelchair.

A patient who requires a power wheelchair usually is totally non-ambulatory and has severe weakness of the upper extremeties due to a neurological or muscular disease/condition. If the documentation does not support the medical necessity of a power wheelchair but does support the medical necessity of a manual wheelchair, payment is based on the allowance for the least costly medically appropriate alternative. However, if the power wheelchair has been purchased, and the manual wheelchair on which payment is based is in the capped rental category, the power wheelchair will be denied as not medically necessary. Options that are beneficial primarily in allowing the patient to perform leisure or recreational activities are non-covered.

2. A power operated vehicle (POV) is covered when all of the following criteria are met:

• The patient's condition is such that a wheelchair is required for the patient to get around in the home.
• The patient is unable to operate a manual wheelchair.
• The patient is capable of safely operating the controls of the POV.
• The patient can transfer safely in and out of the POV and has adequate trunk stability to be able to safely ride in the POV.

Most POVs are ordered for patients who are capable of ambulation within the home but require a power vehicle for movement outside the home. POVs will be denied as not medically necessary in these circumstances. A POV that is beneficial primarily in allowing the patient to perform leisure or recreational activities will be denied as not medically necessary. If a POV is covered, a wheelchair provided at the the same time or subsequently will usually be denied as not medically necessary.

3. Manual wheelchairs are covered by Medicare, but only as a "Capped Rental." This means that Carolina Apothecary rents chairs and bills Medicare for the rental payments each month.

For more information, call (336) 342-0071