Changes to Medicare Policy Effecting Durable Medical Equipment Effective 12/8/03

• Zero inflation increase in Medicare allowable for Power Wheelchairs or Scooters until 2007

• Beginning in 2005, a 3.28% reduction in reimbursement from Medicare for power wheelchairs

• Physician may not prescribe a Scooter or Power Wheelchair without a face to face examination

• There must be a proof of Prescription in patients medical chart notes

• Overall higher degree of scrutiny in Medicare claims dealing with Power Wheelchairs and Scooters

A Power Wheelchair is Covered by Medicare when all of the following criteria are met:                                                                             

     1.) The patient's condition is such that without the use of a wheelchair the patient would otherwise be bed or chair confined; and

     2.) The patient's condition is such that a wheelchair is medically necessary and the patient is unable to operate a wheelchair manually;  and

     3.) The patient is capable of safely operating the controls for the Power Wheelchair

Medicare's Current Coverage Criteria for a POV (scooter) Effective (winter) 03

A Power Operated Vehicle (POV) is covered by Medicare  when all of the following criteria are met:

     1.) The patient's condition is such that without the use of a wheelchair the patient would not be able to move around in their residence; and

     2.) The patient is unable to operate a manual wheelchair; and

     3.) The patient is capable of safely operating the controls of a POV; and

     4.) The patient can transfer safely in and out of the POV and has adequate trunk stability to be able to safely ride in the POV; and

     5.) It is ordered by a physician who is one of the following specialties: Physical Medicine, Orthopedic Surgery, Neurology, or Rheumatology.

   ****Coverage Criteria taken directly from the Medicare Supplier Manual and can be found at:****

http://www.palmettogba.com

For More Information:

Medicare                       Phone: (866)270-4909                www.cms.hhs.gov

Medicaid                       Phone: (800)221-3943                 www.cms.hhs.gov/medicaid/gov

USA Mobility                Phone: (800)309-1667                www.usamobilityinc.com