Clinicians - Are You Ordering Wheelchair Options and Accessories for Your Patients? - JA DME

Wheelchair options and accessories are covered under the Durable Medical Equipment (DME) benefit, as defined by the Social Security Act §1861(s)(6). These items are reimbursable by Medicare if:

• The beneficiary has a wheelchair that meets Medicare coverage criteria, and
• The option or accessory is medically necessary.

Medicare may require a face-to-face encounter with the beneficiary prior to ordering the wheelchair and its related accessories. In many cases, a licensed, certified medical professional (LCMP) – typically a physical therapist or occupational therapist – will be involved and conduct their own specialty evaluation. You may also need to review, indicate agreement, sign and date the evaluation.

The majority of power wheelchair bases also require input from an Assistive Technology Professional (ATP), who is employed by the supplier. This RESNA-certified individual will have direct, in-person involvement in the provision of the wheelchair base and related accessories. It is a common practice for the ATP to have close contact with the PT/OT conducting the specialty evaluation and will provide you with copies of their assessments.

Most power mobility devices require prior authorization from Medicare before the wheelchair can be delivered to your patient. You are a partner with the durable medical equipment (DME) supplier in helping your patient meet their mobility goals so please provide medical records and chart notes to them when requested. The practitioner who conducts the face-to-face encounter must complete the order for a power wheelchair base in its entirety. These wheelchair bases are included in written order prior to delivery (WOPD) by Medicare, so this order must be completed and submitted to the supplier in a timely manner. It is also important to review and sign orders for the wheelchair accessories soon after you receive them from the DME supplier.

A valid standard written order (SWO) must be in the DME supplier’s possession before they can submit claims or prior authorization requests to the Medicare program. The DME supplier will provide you with an SWO that lists all applicable accessories. This SWO will contain the following elements:

• Beneficiary's name or Medicare Beneficiary Identifier (MBI)
• Order date
• General description of the item
  • The description can be either a general description (e.g., elevating legrests), a HCPCS code, a HCPCS code narrative, or a brand name/model number
  • For equipment – In addition to the description of the base item, the SWO may include all concurrently ordered options, accessories, or additional features that are separately billed or require an upgraded code (list each separately)
• Quantity to be dispensed, if applicable
• Treating practitioner name or NPI
• Treating practitioner's signature

Adhering to Medicare coverage guidelines support both your patients and the program by ensuring that medical documentation justifies the need for wheelchair bases, options, and accessories. Your role in providing accurate and complete documentation helps Medicare process claims appropriately and ensures your patients receive the medically necessary equipment you’ve prescribed.

The LCD and Policy Article for wheelchair options and accessories are located on the DME MAC websites.