Medicare’s Wheelchair & Scooter Benefit
The doctor treating your condition submits a written order stating that you have a medical need for a wheelchair or scooter for use in your home and You have limited mobility and meet all of these conditions:
Rule 1You have a health condition that causes significant difficulty moving around in your home.
Rule 2You’re unable to do activities of daily living (like bathing, dressing, getting in or out of a bed or chair, or using the bathroom) even with the help of a cane, crutch, or walker.
Rule 3You’re able to safely operate and get on and off the wheelchair or scooter, or have someone with you who is always available to help you safely use the device.
Rule 4Your doctor who is treating you for the condition that requires a wheelchair or scooter and your supplier are both enrolled in Medicare.
Rule 5You can use the equipment within your home (for example, it’s not too big to fit through doorways in your home or blocked by floor surfaces or things in its path).
If you’re in a Medicare Advantage Plan (like an HMO or PPO), contact your plan to find out about costs.
You must have a medical need for Medicare to cover a power wheelchair or scooter
Types of equipment
If you can’t use a cane or walker safely, but you have enough upper body strength or you have someone available to help, you may qualify for a manual wheelchair. You may have to rent the most appropriate manual wheelchair first, even if you eventually plan to buy it.
If you can’t use a cane or walker, or can’t operate a manual wheelchair, you may qualify for a power-operated scooter. To qualify, you must be able to get in and out of it safely and strong enough to sit up and safely operate the controls.
If you can’t use a manual wheelchair in your home, or if you don’t qualify for a power-operated scooter because you aren’t strong enough to sit up or to work the scooter controls safely, you may qualify for a power wheelchair.
Note: Before you get either a power wheelchair or scooter, you must have a face-to-face exam with your doctor. The doctor will review your needs and help you decide if you can safely operate the device. If so, the doctor will submit a written order telling Medicare why you need the device and that you’re able to operate it.
Prior authorization of certain equipment
You may be affected by a Medicare program called “prior authorization.” Under this program, your durable medical equipment (DME) supplier will need to:
- Request “prior authorization” for certain types of power wheelchairs (listed below)
- Send the required documents to Medicare along with the request
You can choose to submit the request yourself if you get the required documents from your doctor and DME supplier. Medicare will review the information to make sure that you’re eligible and meet all requirements for the item. Under this program, your Medicare coverage and benefits will stay the same and you shouldn’t experience delays getting the items you need.
At this time, these 2 types of power wheelchairs require “prior authorization” in all 50 states:
- K0856: Power wheelchair, group 3 std., single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
- K0861: Power wheelchair, group 3 std., multiple power option, sling/solid seat/ back, patient weight capacity up to and including 300 pounds
Your doctor or supplier must get pre-approval (prior authorization) for other types of power-operated scooters and wheelchairs if you live in one of these states: Arizona, California, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maryland, Michigan, Missouri, North Carolina, New Jersey, New York, Ohio, Pennsylvania, Tennessee, Texas, or Washington.
For more information
Our team is here for you just phone call away every day. To get more information, call 1-800-MEDICARE.