REQUIREMENTS FOR POWERCHAIRS UNDER INSURANCE COVERAGE

Step #1 Face to Face Evaluation

The face to face evaluation is a time for a physician to sit down with the patient and discuss obtaining a powerchair. The physician must completely evaluate the patient to determine whether or not the patient truly needs a powerchair to aid in Activities in Daily Living (ADL's) ruling out the use of a cane, walker, manual wheelchair, or a manually steered electric scooter within the patients home.  

If they can't be ruled out then there is no need to proceed to the next 3 steps.                                                                                                 

Step #2 Prescription

Patients name and office visit date

ICD-9 Codes and length of need in months

(a lifetime need is shown as '99 months')

Product description 'power wheelchair and batteries'

Any necessary accessories

Physician signature with date and UPIN #  

Step #3 Detailed Narrative Note

The detailed narrative note must be on official letterhead, using complete sentences to state the following:(must be sent to equipment provider within 45 days of face to face evaluation or the evaluation will expire.)

1. Whether or not the patient is willing and motivated to use a powerchair.

2. Whether or not the patient is physically and mentally capable to safely operate a  power chair in the home.

3. How the patients ability to walk has deteriorated over time and why.

4. What the patients height and weight is and the mobility problems that are keeping  him/her from doing one or more activities of daily living (ADL's) within the home.

5. Why the use of a cane, walker, manual wheelchair, and a manually steered electric  scooter has been ruled out as mobility aid options.

 

Step #4 Detailed Product Description

The detailed product description with HCPCS codes and pricing is created by Specialized Mobility LLC and requires only a physicians signature and date. It must be signed prior to the delivery of a powerchair.