Patients

Patients

Whats your role?

  1. Know what type of equipment you need.
  2. If you have an existing piece of equipment know what you liked and did not like, or would like to change.
  3. Plan to have your family and caregivers present, to ensure all your needs are met during the time of our scheduled evaluation appointment.

Who should be involved?

  • Patients
  • Family
  • Caregivers
  • Teachers (if applicable)
  • Physicians
  • Therapists & Assistive Technology Professionals (ATP)
  • Durable Medical Equipment (DME) Suppliers & Assistive Technology Providers (ATP)
  • Manufacturer representatives (if there are new products we need to trial)

How do I get started?

  • Complete a visit with their primary care physician or specialist
  • Obtain a doctor’s prescription for “PT / OT Evaluation” with a medical diagnosis
  • Obtain a second doctor’s prescription for mobility “evaluation” for one of the following:
  1. manual wheelchair
  2. power mobility device
  3. manual tilt in space wheelchair
  4. seating and positioning
  5. home assessment
  6. wheelchair training

Ask your physician to fax the prescription to the equipment provider you are working with or email to our secure and HIPPA Compliant email Christina@seatingspecialist.net

When can I replace my current mobility devise?

  • Follow the process outlined above
  • According to the Medicare Benefit Policy Manual, carriers may determine the reasonable useful lifetime of equipment, but in no case can be less than 5 years (from date of delivery), Replacement due to wear is not covered during the reasonable useful lifetime of the equipment.
  • During the reasonable useful lifetime, Medicare does cover repairs up to the cost of replacement (but not actual replacement) for medically necessary equipment.

Replacement of equipment may be accomplished in one of the following situations:

  1. The equipment has irreparable wear and deterioration from day-to-day usage over time and a specific event cannot be identified. Replacement due to irreparable wear takes into consideration the reasonable useful lifetime of the equipment. A new physician’s order and documentation is necessary to reaffirm the medical necessity of the item to be replaced.
  2. The equipment has irreparable damage due to a specific accident or to a natural disaster (e.g., fire, flood). A new physician’s order and documentation is necessary to reaffirm the medical necessity of the item to be replaced.
  3. The equipment no longer meets the beneficiary’s medical and functional needs because he or she suffered a significant change in their medical condition. A new physician’s order and documentation is necessary to affirm the medical necessity of the item to be replaced.

*****The Medicare Benefit Policy Manual does not state that equipment is routinely replaced every 5 years (from date of delivery to your home.)

How do I get repairs?

Call or visit your physician for a prescription for wheelchair repairs, have your physician fax to the provider who delivered the mobility device initially. A service technician from your provider company will provide parts and service as approved by your insurance.

How do I qualify?

Per Center for Medicare and Medicaid Services (CMS)

Manual wheelchairs

  • The patient has a mobility limitation that does not safely allow them to complete the following in the home:
  1. Toileting
  2. Feeding
  3. Dressing
  4. Grooming
  5. Bathing
  • The patient cannot sufficiently and safely use a cane or walker
  • The patient can self-propel an optimally configured manual wheelchair in the home

Power Operated Vehicle (POV)/Scooter

  • The patient meets all general coverage criteria for above criteria PLUS all the following:
  1. Unable to propel an optimally configured manual wheelchair
  2. Safely transfer to and from a POV
  3. Operate the tiller steering system
  4. Maintain postural stability and position while operating the POV in the home
  5. Mental capabilities are sufficient for safe mobility using a POV in the home
  6. Physical capabilities are sufficient for safe
    mobility using a POV in the home
  7. The patient’s home provides adequate access between rooms, maneuvering space, and surfaces for the operation of the POV

Power wheelchair (PWC)

  1. The patient does not meet the coverage criteria for a POV
  2. The patient has the mental capabilities and physical capabilities to safely operate
    the PWC, or, if unable to safely operate the PWC, has a caregiver who is available and willing
  3. The patient is able to safely operate the PWC, but is unable to adequately propel an optimally configured manual wheelchair
  4. The patient’s home provides adequate access between rooms, maneuvering space, and surfaces for the operation of the power wheelchair
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