Medicare Guidelines

If your patient requires the use of a power wheelchair or scooter, here is a simple guide to aid in documenting the information required by Medicare.

1. 1. You must conduct a face-to-face evaluation before you prescribe a scooter or power wheelchair. You may bill an add-on code of GO372 to receive additional payment for your time.
   2. You must incorporate specific information into the patient chart, either through dictation or writing, that qualifies your patient for the level of equipment that you are prescribing. If you are not comfortable performing this evaluation due to reasons such as severe deformities or need for a complex power wheelchair, you may refer your patient to a physical or occupational therapist for a comprehensive evaluation. For simple power mobility, a short office evaluation with the following information will suffice. This information includes but is not limited to:
      • Why does your patient need a mobility device? For example, a medical diagnosis, physical impairments, and daily activities not able to be performed independently in a timely manner.
      • Can your patient safely use a mobility device or be trained to use the device? Do mental or physical impairments prohibit use?
      • Why can’t a cane, walker, or manual wheelchair be used to satisfy the reason your patient needs the mobility device listed at the beginning of  step 2?
      • Can your patient operate a three- or four-wheeled scooter steered by tiller steering, and does this device overcome their reason for requiring the equipment at the beginning of step 2? (Please refer to the use chart for reference.) If yes, write the order for scooter, also referred to as P.O.V. If no, why not?
      • If a basic power wheelchair is required by your patient, will it satisfy your patient’s needs for receiving a mobility device listed at the beginning step 2? If not, can the addition of custom items such as power positioning, positioning pads, cushions, or specialty controls be added to overcome these deficits? If no, write an order for a power wheelchair. If yes, please refer to a RESNA-certified A.T.S. due to specific Medicare restrictions effective April 1st, 2008.