Understanding the Eligibility of Wheelchairs for Medicare Coverage

When buying a wheelchair for an elderly or a handicapped person eligible for medicare coverage, there are certain CMS requirements to take into account. The Centers for Medicare and Medicaid Services (CMS) undertakes to cover 80% of wheelchair cost if it meets the agency’s definition of Durable Medical Equipment (DME).

First off, under CMS policies, wheelchairs covered as DMEs must serve a medical purpose. Generally, doctors prescribe a lightweight manual wheelchair if the patient cannot use a walker, but has sufficient upper body strength to manually operate the mobility device; or has someone in attendance to provide assistance.

The CMS recommends that before actually buying a manual wheelchair, it would be best to rent first to find the right Lightweight Wheelchairs. That way, deciding on a brand or model of wheelchair as the best fit will be based on actual use of the elderly or person with disability. .

CMS Approval for Wheelchair Claim Based on Performance and Safety of DME for User Need

As the title Durable Medical Equipment implies, a wheelchair is covered only if it is sturdy enough to withstand repeated and prolonged use for at least three years.

The CMS wants to make sure that the DME is durable and has backup features in case of failures. A manual wheelchair is the most recommended mobility device for regular use when moving about inside or outside of the home because it is much lighter than the electric type. However, whether manual or electrically driven, the CMS also looks into performance and safety tests. That way, frequent purchases for a replacement can be avoided, while risks of injury can be mitigated.

Qualifications for an Electric Wheelchair

Electric wheelchairs are prescribed by doctors only if the patient does not have enough body strength to operate a manual wheelchair; allowing for mobility on one’s own inside and outside the home. However, the guidelines for electric wheelchair claims are more rigid as the CMS requires submission of a certification issued by the physician giving medical care to the wheelchair user.

The certification must include a statement attesting that the elderly or the disabled person for whom the wheelchair was prescribed has been in face-to-face consultation with the certifying doctor. Mainly because the doctor’s certification must include a statement that in prescribing the DME, the needs as well as the ability of the patient to operate an electric wheelchair have been carefully assessed.