Power Wheelchair

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Power Wheelchair  Process Flow

CLICK to PRINT Criteria for Power Wheelchair

Power Mobility Equipment (Power Scooter & Power Wheelchair)

The primary reason/complaint for the face-to-face doctor visit should be stated as, “Mobility Evaluation”.The Face-to-Face report should be a detailed narrative in the patients chart/SOAP notes detailing the mobility examination.Once the face to face examination is completed the *prescription must be provided to the supplier within 45 days of the exam.The prescription must include the following 7 elements: 


  1. Beneficiary name.   
  2. Description of the item that is to be ordered.  
  3. Date of completion of the face-to-face exam with the doctor 
  4. Pertinent diagnosis/conditions that relate to the need for the power mobility device or power wheelchair.
  5. Length of need.
  6. Physician’s signature and date.
  7. Physician’s NPI number.

Criteria questions for power mobility equipment include:

  1. What is the patient’s mobility limitation and how does it interfere with activities of daily living, such as bathing, dressing, grooming, eating and getting to the bathroom? (Include information such as: patient symptoms; related diagnosis; how long the condition has been present; clinical progression; interventions that have been tried; presence of abnormal tone or deformity of arms, legs and trunk; neck trunk and pelvic posture and flexibility; sitting and standing balance; etc.)The patient cannot walk on his/her own, even with the support of mobility equipment.
  2. Why can’t a cane, walker, or manual wheelchair meet the patient’s mobility needs in the home? (Include information such as: impairment of strength, range of motion, sensation or coordination of arms and legs; past use of cane or walker; past use of manual wheelchair, etc.)
  3. If prescribing a power wheelchair: why can’t a scooter meet the patient’s mobility needs in the home? (Include information such as: physical limitations preventing safe transfer into and out of the scooter or operation of the tiller steering system; lack of postural stability requiring more supportive seating, etc.)
  4. Does the patient have the physical and mental capabilities to operate the power wheelchair or scooter in the home? (The primary use should be in the home)