Power Operated Vehicles
Basic Types of POV's
Medicare has set up two basic classes of POV's called Group 1 and Group 2.
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 patientís mobility limitation cannot be sufficiently resolved by the use of an appropriately fitted cane or walker.
C) The patientís 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
∑Maintain postural stability and position while operating the POV in the home.
E) The patientís 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 patientís home provides adequate access between rooms, maneuvering space, and surfaces for the operation of the POV that is provided.
G) The patientís 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 patientís 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.
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 patientís 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.
The report of your face-to-face examination should provide information relating to the following questions:
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.
You may choose to refer your patient to a licensed/certified medical professional (LCMP) (ie: PT/OT) to perform part of this 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:
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.
Medicare has done away with the CMN for power mobility devices and is relying upon the patientís clinical record to substantiate and justify the need for the PMD. Medicare expects that the patientís 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 patientís 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 patientís 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 patientís chart is no substitute for the comprehensive medical record.