Prior Authorization for Manual Wheelchairs - JD DME
Prior Authorization for Manual Wheelchairs
Due to the CMS final rule 42 CFR §§405 and 414., in 2016, a Prior Authorization (PA) process for certain DMEPOS that are frequently subject to unnecessary utilization was established. In November 2019, CMS standardized regulations regarding Prior Authorization (PA) to create a Master List of DMEPOS that can be subject to PA and/or a Face-to-Face encounter and a Written Order Prior to Delivery.
Beginning October 28, 2026, prior authorization for the K0005 manual wheelchair will be required nationwide.
Manual Wheelchair Coverage
Prior Authorization Timelines
| Policy | Initial Review Decision Timeframe | Expedited Review Decision Timeframe | PAR Decision Valid |
|---|---|---|---|
| MWC | 5 business days (not to exceed 7 calendar days) | 2 business days | 6 months |
Access the below related information from this page.
Documentation to Include for Submission
For documentation requirements, refer to the Browse by DMEPOS Category web page for manual wheelchairs
Decision Letters
Treating practitioners involved in the submission of a prior authorization may request a copy of the decision letter.
- Treating practitioner requesting the letter must be able to demonstrate a legitimate, specific need for information requested
- Request may be sent in with PA request or separately
Still Have Questions?
Call the Supplier Contact Center or Interactive Voice Response (IVR).
