Medicare has many rules and stipulations when it comes to paying for any type of mobility equipment. This includes a cane, walker, wheelchair, power scooter, power wheelchairs, and transport chairs. Some of the equipment can be purchased and others can only be on a rental basis. Here is some basic information to help you with deciding which mobility equipment would be best according to how Medicare’s guidelines work.
At first many people may experience an unsteady gait with age. The first step to receiving a device would be to contact your physician. They should determine the cause and will frequently start off ordering a cane. A simple prescription from your physician stating “cane” and your diagnosis is all you need to have us process the claim through Medicare. Medicare only pays for least costly alternative but you may choose an upgrade option if you would like something fancy.
As time progresses a cane may no longer be suitable and the patient now needs a walker for more support. A walker is also frequently ordered for rehabilitation of a stroke patient. Again just a prescription with a diagnosis is needed. However, always remember if you are seeking a 4 wheeled walker with a seat, the physician must specify this on the prescription.
When a patient becomes wheelchair bound, Medicare requires we look at long term and short term needs. A healthy patient that is needing a wheelchair short term for a surgery or broken leg would only qualify for a standard wheelchair. Medicare will only provide this on a rental basis. A patient, who is a paraplegic, would qualify for a much more custom fit manual wheelchair as a purchase. The paperwork for the standard chair takes a day or two to get completed from the physician. The provider must have on file chart notes or a face to face evaluation form showing the patient qualifies. For the more custom chair, an evaluation would be required by healthcare professional not affiliated with the provider. There are also forms the provider will supply to physician to complete. Only after all documentation is received would the supplier be able to order the custom equipment.
Powered operated equipment is much more involved. Many people would like to have independence outside the home even though they are still able to manage in the home with a walker or manual wheelchair. In this case Medicare will not help with the purchase of a scooter or power wheelchair. For any patient to qualify for a powered piece of equipment the first rule is the need for inside the home. If they physician determines the patient must absolutely have this equipment for activities of daily living in the home, the paperwork then begins. A face to face with the physician, prescription, evaluation by a therapist specializing in the equipment, and detailed order provided to the physician by the supplier will all need to be on file before ordering. There are time lines and many specific details regarding the paperwork. This can sometimes take several trips to the physician and a few months to be just right in order for a patient to qualify. It is not just medical necessity any longer; it is also the documentation requirements that matter.
Lastly Medicare will consider what is commonly known as a transport chair. This is for patients that are no longer able to self propel a manual chair and are no longer cognitively able to use a power wheelchair. This should not go through Medicare as a convenience item to just transport the patient long distances. If for instance someone elderly can walk short distances fine but require something for outside the home, the patient or family should purchase the equipment as it is only considered by Medicare convenience. If a patient does get a transport chair and then later wants a power chair due to a decline in condition, it would be denied by Medicare for same or similar equipment. Also remember, Medicare will not provide any type of cushion on a transport chair. If a patient develops a pressure wound, the cushion normally costs over $400.00. It is highly recommended that when considering a transport chair, all the guidelines for present and future needs are considered.
Medicare considers replacement equipment every 5 years. At the end of 5 years, if the patient requests new equipment, the equipment must be evaluated to see if it is in need of repair or if it would be less costly to purchase a new one. Again, Medicare wants to choose the least costly alternative. The only exceptions to the 5 year rule are if the patient has had a major change in condition, or the equipment was lost/stolen.