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Wheelchairs

Following are coverage criteria of wheelchairs:

Exclusions:

Wheelchair Replacement Items
Following are coverage criteria for wheelchair replacement items:

Commode Seat, Wheelchair
Wheelchair commode seats may be covered when the patient is wheelchair or room-confined. Reimbursement includes the pad, pan and accessories.

Wheelchair Belts and Safety Vest
Wheelchair belts and safety vests may be covered when the patient's medical condition is such that he/she is otherwise unable to remain safely seated in the wheelchair (i.e., severe spasticity and/or weakness of upper body).

Heavy-Duty Wheelchair
Heavy-duty wheelchairs may be covered if the following criteria are met:

Lightweight Wheelchair
Lightweight (manual) wheelchairs such as Geri, reclining, Hemi, high-strength lightweight, youth, wide heavy-duty, standard and amputee may be covered if the following criteria are met:

High-Strength Lightweight Wheelchair
Benefits are provided for high-strength lightweight wheelchairs if the following criteria are met:

Roll-About Wheelchair, Patient Transfer System, Transport Wheelchair
Following are the coverage criteria for roll-about wheelchairs, patient transfer systems and transport wheelchairs:

Standard, Fully Reclining, Semi-Reclining, or Amputee Wheelchairs
Benefits are provided for standard, fully reclining, semi-reclining or amputee wheelchairs if basic wheelchair requirements are met, the wheelchair is prescribed by the patient’s physician, and a DME Certification Form is on file.

Hemi-Wheelchair (Low Seat)
Benefits are provided for hemi-wheelchairs (low seat) if the following criteria are met:

Motorized/Power Wheelchair
Benefits are provided for motorized/power wheelchairs if the following criteria are met:

Note: Prescriptions from other specialists are considered when documentation of medical criteria for coverage is provided.

Power-Operated Vehicle (POV) (Three or Four Wheel Non-Highway)
Benefits are provided for POV, three or four wheel non-highway, if the following criteria are met and the brand name and model number is specified:

Exclusions:

POV/PWC Basic Equipment Package: Each POV/PWC is to include all of the following items on initial issue (i.e., no separate billing/payment at the time of initial issue):

Wheelchair, Customized
Benefits are provided for customized wheelchairs if the following criteria are met:

Exclusions:

Last Updated July 2010