A power wheelchair (K0823-K0849) is covered by Medicare when a patient's condition is such that the patient cannot perform normal activities of daily living (ADL's) safely in the home without one. Additionally, the patient is unable to operate a manual wheelchair due to a severe neurologic or muscular condition of the upper extremities (such as arthritis in the arms/shoulders, or other condition creating weakness in the hands/arms/shoulders).
Examples of conditions that might qualify an individual for a power wheelchair are arthritis, COPD, diabetes with neuropathy, spinal cord disease, multiple sclerosis, or stroke. In addition to the diagnosis of such a condition, there must also be functional impairment involving paralysis or such severe weakness of arms as well as legs that the patient is unable to propel a manual wheelchair within the confines of their home or individual living quarters.
Medicare has received many claims with documentation of the need for power wheelchairs including statements signed by physicians, indicating a degree of functional impairment and use within the home or living quarters, which has not been corroborated when further investigated. In an effort to better determine the medical necessity for power wheelchairs (K0823-K0849), Medicare requires the following documentation from your doctor:
- A prescription with diagnoses that is based on a Face-to-Face evaluation.
- The manufacturer and model/number of the power wheelchair ordered, delivered and used by the patient, which must be the same item for which the claim is being submitted.
- Copies of the Progress Notes from the medical chart of the treating physician who is ordering the power wheelchair. These notes must be relevant to the diagnoses listed on the Prescription, and address functional levels justifying the need for the power wheelchair.
Failure to provide adequate and relevant copies of the treating physician's Progress Notes from the physician's medical chart of the patient will be considered lack of adequate medical necessity documentation, and the power wheelchair will be denied as medically unnecessary.