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Preventing Denials for Manual Wheelchairs

March 8th, 2018 - Medicare Learning Network
Categories:   Denials & Denial Management   DME|Supplies|Equipment  
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The Medicare Learning network provides guidance on how to prevent denials for Manual Wheelchair Bases:

Determine if, according to the Local Coverage Determination (LCD) Manual Wheelchair Bases (L33788) and Local Coverage Article for Manual Wheelchair Bases – Policy Article (A52497):

  1. The beneficiary has a mobility limitation that significantly impairs their participation in mobility-related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing in customary locations within the home.
  2. The beneficiary’s mobility limitation cannot be sufficiently resolved by the use of an appropriately fitted cane or walker.
  3. The beneficiary’s home provides adequate access between rooms, maneuvering space, and surfaces for using the provided manual wheelchair.
  4. Use of a manual wheelchair will significantly improve the beneficiary’s ability to participate in MRADLs and the beneficiary will use it on a regular basis in the home.
  5. The beneficiary uses the manual wheelchair that is provided in the home.
  6. The beneficiary has sufficient upper extremity function and other physical and mental capabilities needed to safely self-propel the manual wheelchair that is provided in the home during a typical day. Limitations of strength, endurance, range of motion, or coordination, presence of pain, or deformity or absence of one or both upper extremities are relevant to the assessment of upper extremity function.
  7. The beneficiary has a caregiver who is available, willing, and able to provide assistance with the wheelchair.
Please note that for use inside the home, a manual wheelchair must meet criteria A, B, C, D, E, and F or G above.

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