Power wheelchairs:

All Power Mobility Devices

A Medicare patient must meet all of these general coverage criteria to satisfy PMD medical necessity requirements for all power mobility devices: 

• He or she has a mobility limitation that significantly impairs his or her ability to participate in one or more Mobility-Related Activities of Daily Living (MRADLs) in customary locations in the home 
• His or her mobility limitation cannot be sufficiently and safely resolved by using an appropriately fitted cane or walker 
• He or she does not have sufficient upper extremity function to self-propel an optimally configured manual wheelchair in the home to perform MRADLs during a typical day

Power Wheelchair (PWC) For PWCs, the patient meets all general coverage criteria for PMDs and all of these criteria:

•  He or she does not meet the coverage criteria for a POV 
• He or she has the mental and physical capabilities to safely operate the PWC or if he or she is unable to safely operate the PWC, has a caregiver who is available, willing, and able to safely operate the PWC (but is unable to adequately propel an optimally configured manual wheelchair) 
• His or her weight is less than or equal to the weight capacity of the PWC and greater than or equal to 95 percent of the weight capacity of the next lower weight class of PWC Power Mobility Devices MLN Booklet Page 5 of 12 ICN 905063 October 2017 
• His or her home provides adequate access between rooms, maneuvering space, and surfaces for operating the PWC 
• Using a PWC will significantly improve his or her ability to participate in MRADLs, and the patient will use the PWC in the home 
• He or she has not expressed an unwillingness to use a PWC in the home Additional coverage criteria apply for specific PWCs. Search the Medicare Coverage Database for your geographic area’s Power Mobility Devices Local Coverage Determination. 

Custom Manual Wheelchairs:

A Medicare patient must meet all of these general coverage criteria to satisfy PMD medical necessity requirements for all manual wheelchairs:

• Patient has mobility limitations significantly impairing their participation in mobility-related activities of daily living (MRADLs) (for example, toileting, feeding, dressing, grooming, and bathing in customary locations within the home) that meet 1 of these:
• Prevents them from accomplishing an MRADL entirely
• Places them at reasonably found heightened risk of morbidity or mortality secondary to trying to do an MRADL
• Prevents them from completing an MRADL within a reasonable time frame
• Using a properly fitted cane or walker doesn’t resolve the patient’s mobility limitation
• Patient’s home allows adequate access between rooms, maneuvering space, and surfaces for using the specific manual wheelchair
• Using a manual wheelchair will significantly improve the patient’s ability to take part in MRADLs and they will use it regularly in the home
• Patient hasn’t expressed an unwillingness to use a manual wheelchair in their home
• Patient has enough upper extremity function and other physical and mental abilities to safely self-propel the manual wheelchair in their home during a typical day (strength limitations, endurance, range of motion, coordination, presence of pain, or deformity or absence of 1 or both upper extremities are relevant to assessing upper extremity function)
• Patient’s caregiver is available, willing, and able to help with the wheelchair