Is A Wheelchair Covered By Medicare?

According to Medicare.gov, Medicare Part B (Medical Insurance) extends coverage to power-operated vehicles, encompassing scooters and manual wheelchairs, provided they are prescribed by a physician for domestic use. A mandatory face-to-face consultation with a doctor or qualified healthcare provider is required, and a valid prescription must be obtained prior to Medicare authorization for payment.

Does Medicare Cover Wheelchairs?

Should your supplier participate in the Medicare assignment program, you will typically incur responsibility for 20% of the Medicare-Approved Amount. The Part B deductible is applicable in this context, as Medicare reimburses for various categories of durable medical equipment (DME) according to different methodologies.

The acquisition or rental of equipment substantially influences the extent of Medicare coverage provided. Medicare coverage is contingent upon both your physician and medical equipment supplier maintaining current enrollment status with Medicare.

Both practitioners and suppliers are obligated to adhere to rigorous enrollment standards to maintain their participation status. Coverage will be denied if either party lacks current Medicare enrollment. It is essential to verify in advance whether your physician and supplier maintain active Medicare enrollment.

Participating suppliers operating under assignment agreements are restricted to charging patients exclusively for coinsurance and the Part B deductible corresponding to the Medicare-Approved Amount. Conversely, suppliers not enrolled in Medicare operate without such restrictions and may charge patients without limitation.

Medicare Approvals And Denials

In September of 2018, it was ruled that all patients must receive “prior authorization” for different kinds of power wheelchairs. Currently, there are 40 types of wheelchairs that require this approval – check out the full list right here. Prior authorization is needed before Medicare will approve covering the cost of the wheelchair.

DME suppliers need to do the following before receiving approval:

• Request prior authorization ahead of time.
• Submit said request and other required documentation to Medicare.

The patient generally does not have to do anything at this point of the process. The supplier is responsible for all the work detailed above. The specific DME supplier will need to send the request for authorization, including all documentation to Medicare on the patient’s behalf. Medicare will then review the request to ensure the patient is eligible for coverage.

Ultimately, coverage could be denied due to the following reasons:

• Medicare says that you do not need a power wheelchair.
• Medicare did not receive sufficient documentation.

How Much Do Wheelchairs Cost?

Manual, transport, and electric are the three main types of wheelchairs. Costs for these wheelchairs can range all the way from $90-$9,000, depending on the type. Prices vary based on model, with the transport being the least expensive version.

Here are some average costs associated with wheelchairs today:

• Average Transport Wheelchair Cost: $955.
• Average Manual Wheelchair Cost: $1,400.
• Average Electric Wheelchair Cost: $3,750.

*Please note these are cost estimates according to Braunability. 

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