Physician's Resources
Power Operated Vehicles
(Scooters)
Basic Types of POV's
Medicare has set up two basic classes of POV's called Group 1 and Group 2.
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Group 1 POV's are designed to be used primarily indoors.
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Group 2 POV's have added capabilities that are not needed for in home use. These POV's are better suited for outdoor use. Medicare will cover Group 2 POV's at the same rate as Group 1 POV's as long as the following criteria are met.
Coverage Criteria
These are the basic coverage requirements for POV's (scooters) as outlined by Medicare.
A POV is covered if all of the basic coverage criteria (A-C)
have been met AND if criteria D-I are also met.
A) The patient has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home.
- A mobility limitation is one that:
1) Prevents the patient from accomplishing an MRADL entirely, or
2) Places the patient at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform an MRADL; or
3) Prevents the patient from completing an MRADL within a reasonable time frame.
B) The patient’s mobility limitation cannot be sufficiently resolved by the use of an appropriately fitted cane or walker.
C) The patient’s home provides adequate access between rooms, maneuvering space, and surfaces for use of the manual wheelchair that is provided.
D) The patient is able to:
· Safely transfer to and from a POV, and
· Operate the tiller steering system, and
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Maintain postural stability and position while operating the POV in the home.E) The patient’s mental capabilities (e.g., cognition, judgment) and physical capabilities (e.g., vision) are
sufficient for safe mobility using a POV in the home.
F) The patient’s home provides adequate access between rooms, maneuvering space, and surfaces for the operation of the POV that is provided.
G) The patient’s weight is less than or equal to the weight capacity of the POV that is provided.
H) Use of a POV will significantly improve the patient’s ability to participate in MRADLs and the patient will use it in the home.
I) The patient has not expressed an unwillingness to use a POV in the home.
If a POV will be used inside the home and coverage criteria A-I are not met, it will be denied as not medically necessary.
Face-To-Face Evaluation
Medicare law now requires that beneficiaries have a face to face examination by their physician in order to determine if a Power Mobility Device (PMD), such as a power wheelchair or POV/scooter is reasonable and necessary. The face to face exam should address and document in the patient’s clinical record all of the points in the 9 step algorithm outlined above.
Keep in mind the following points when performing and documenting your examination of the patient.
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Document just those elements that are pertinent to the need for the Power Mobility Device.
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The amount of detail required depends on the nature of your patient’s condition.
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Paint a picture of your patient’s functional abilities and limitations on a typical day.
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Be as quantitative as possible
The report of your face-to-face examination should provide information relating to the following questions:
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What is this patient’s mobility limitation and how does it interfere with the performance of activities of daily living?
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Why can’t a cane or walker meet this patient’s mobility needs in the home?
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Why can’t a manual wheelchair meet this patient’s mobility needs in the home?
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If a POV is to be ordered, does this patient have the physical and mental abilities to transfer into a POV and to operate it safely in the home?
The report should provide pertinent information about the following elements, but may include other details. Each element would not have to be addressed in every evaluation.
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Symptoms · Related diagnoses
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History · How long the condition has been present
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Clinical progression · Interventions that have been tried and the results
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Weight · Physical exam
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Past use of walker, manual wheelchair, POV, or power wheelchair and the results
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Impairment of strength, range of motion, sensation, or coordination of arms and legs
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Sitting and standing balance · Neck, trunk, and pelvic posture and flexibility
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Presence of abnormal tone or deformity of arms, legs, or trunk
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Functional assessment – any problems with performing the following activities including the need to use a cane, walker, or the assistance of another person
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Transferring between a bed, chair, and PMD
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Walking around the home – to bathroom, kitchen, living room, etc. – provide information on distance walked, speed, and balance
You may choose to refer your patient to a licensed/certified medical professional (LCMP) (ie: PT/OT) to perform part of this examination.
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Once you have received and reviewed the PT/OT’s written report you must see the patient (if you did not do so prior to the referral) and perform any additional examination necessary.
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The report of your visit should state your concurrence or any disagreement with the PT/OT examination. If you saw the patient prior to referral to the PT/OT, you should note agreement, sign, and date the report but are not required to see the patient again.
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Medicare’s coverage of a wheelchair is determined solely by the patient’s mobility needs within the home, the examination must clearly distinguish the patient’s abilities and needs within the home from any additional needs for use outside the home.
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It is important to emphasize that even if an LCMP performs a major part of the mobility evaluation, there still must be a face to face examination by the physician. The physician’s examination can be before or after the LCMP’s examination.
Written Order Requirements
The supplier must receive the written order within 45 days of the completion of the face-to-face examination and must contain all of the following elements:
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Beneficiary’s name
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Description of the wheelchair and all related accessories -e.g. “power wheelchair or power mobility device” or may be more specific
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Date of Face to Face examination
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Pertinent diagnosis/conditions that relate to the need for a power wheelchair
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Length of need
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Physician’s signature
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Date of physician’s signature
If your order does not identify the specific type of power wheelchair that is provided, the supplier must clarify this by obtaining another written detailed order which lists the specific power wheelchair that is being ordered and any options and accessories that will be separately billed. The items on the detailed order may be entered by the supplier. This order must be signed and dated by the treating physician and must be received by the supplier prior to dispensing the power wheelchair.
Documentation Requirements
Medicare has done away with the CMN for power mobility devices and is relying upon the patient’s clinical record to substantiate and justify the need for the PMD. Medicare expects that the patient’s medical record will document and justify the need for a PMD using the algorithmic approach explained previously. In lieu of the CMN, the treating physician is now required to provide a copy of the records of his/her face to face examination as well as a written order for the device to the DME supplier. If other parts of the medical record will support the patient’s need for a power mobility device, these should be provided to the DME supplier as well. The DME supplier must receive this clinical documentation and your written order within 45 days after the face-to face examination. In the case of a recently hospitalized beneficiary, the information must be received by the DME supplier within 45 days after the date of discharge.
Documentation of the face to face examination must be a detailed narrative note in the patient’s chart in the same format used by the physician for other entries. A provider supplied or otherwise generic form completed by the physician and added to the patient’s chart is no substitute for the comprehensive medical record.