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Wheelchair Options and Accessories
Medicare Coverage Criteria
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Options and accessories for wheelchairs are covered if the following criteria are met:
The patient has a wheelchair that meets Medicare coverage criteria, and
The patient's condition is such that without the use of a wheelchair, he/she would otherwise be bed or chair confined (a patient may qualify for a wheelchair and still be considered bed confined), and
The options / accessories are necessary for the patient to perform one or more of the following activities:
--- function in the home
--- perform instrumental activities of daily living.
An option / accessory that is beneficial primarily in allowing the patient to perform leisure or recreational activities in not covered.
Adjustable arm height option is covered if the patient requires an arm height that is different than that available using non-adjustable arms and the patient spends at least 2 hours per day in the wheelchair.
Hook-on headrest extension is covered if the patient:
has weak neck muscles and needs a headrest for support, or
meets the criteria for and has a reclining back on the wheelchair.
A fully reclining back option is covered if the patient spends at least 2 hours per day in the wheelchair and has one or more of the following conditions / needs:
---Quadriplegia;
---Fixed hip angle;
---Trunk or lower extremity casts / braces that require the reclining back feature for positioning;
---Excess extensor tone of the trunk muscles;
---and/or
The need to rest in a recumbent position two or more times during the day and transfer between wheelchair and bed is difficult.
A solid seat insert is covered when the patient spends at least 2 hours per day in the wheelchair.
A safety belt / pelvic strap is covered if the patient has weak upper body muscles, upper body instability or muscle spasticity that requires use of this item for proper positioning.
Elevating legrests are covered if:
1 -
the patient has a musculoskeletal condition or the presence of a cast or brace which prevents 90 degree flexion at the knee;
2 - or
the patient has significant edema of the lower extremities that requires having an elevating legrest;
3 - or the patient meets the criteria for and has a reclining back on the wheelchair.
A non-standard seat width, depth or height is covered only if:
the ordered item is at least 2 inches greater than or less than a standard option, and
the patient's dimensions justify the need.
A crutch and cane holder is not medically necessary.
An arm trough is covered if the patient has quadriplegia, hemiplegia or uncontrolled arm movements.
Required Documentation: CMN
Wheelchair options / accessories that require a CMN are detachable, adjustable height armrests; fixed, adjustable height armrests; reclining back feature; and elevating legrests. For these items, a CMN that has been filled out, signed and dated by the ordering physician must be kept on file by the supplier. For items not requiring a CMN, an order for the item, which has been signed and dated by the ordering physician, must be kept on file with the supplier. |
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