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Manual Wheelchairs
Medicare Coverage Criteria |
A standard wheelchair is covered if the patients condition is such that without the use of a wheelchair, he/she would otherwise be bed or chair confined.
A standard hemi-wheelchair is covered when the patient requires a lower seat height (17" to 18") because of short stature or to enable the patient to place his/her feet on the ground for propulsion.
A lightweight wheelchair is covered when both:
1. the patient cannot self propel in a standard wheelchair using arms and/or legs, and
2. the patient can and does self-propel in a lightweight wheelchair.
A high strength lightweight wheelchair is covered when either or both:
1. the patient self-propels the wheelchair while engaging in frequent activities that can not be performed in a standard or lightweight wheelchair, and/or
2. the patient requires a seat width, depth or height that can not be accommodated in a standard, lightweight or hemi-wheelchair, and spends at least two hours per day in the wheelchair.
A heavy duty wheelchair is covered if the patient weights more than 250 pounds or the patient has severe spasticity.
An extra heavy duty wheelchair is covered if the patient weights more than 300 pounds.
A custom wheelchair base is covered only if the feature is not available as an option to an already manufactured base.
Required Documentation: CMN
A certificate of medical necessity, which has been filled out, signed and dated by the physician, must be kept on file by the supplier. The CMN for manual wheelchairs is HCFA Form 844. |
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