First Some Background
You must have Medicare Part B coverage and your doctor must:
1. Have assessed your needs for a Power operated Vehicle, documenting your needs in your medical records,
2. The doctor must write an order (prescription) for the equipment (scooter).
3. The mobility equipment supplier must have the order on file before billing for the scooter.
4. The need for the scooter must meet the following criteria:
- You cannot walk on your own, even with the support of other mobility equipment
- You have weakness in your upper body caused by injury or illness and cannot use a manual wheelchair because of upper body weakness
- You would have to spend most of your time in bed or a chair without the scooter
- You can safely get on and off the scooter, as well as sit on it and work the controls
You must need the scooter to help you move about independently. Medicare will not cover a scooter if the stated need is to prevent an injury.
A power-operated vehicle is usually covered only if it is ordered by a physician who has one of the following specialties: physical medicine, orthopedic surgery, neurology, or rheumatology.
When a specialist is not reasonably accessible (e.g. more than a one day round trip from the patient's home, or the patient's condition precludes such travel), Medicare will individually consider with appropriate documentation from the ordering physician
The following steps must be taken so that Medicare will cover the equipment:
- Only your doctor can prescribe the equipment for you. A sales person may tell you otherwise.
- The doctor must document the need for an electric scooter in your medical records and give you a prescription for the scooter.
- Your mobility equipment supplier must receive the prescription before Medicare is billed.
Medicare Medical Advantage Plan
If you receive your Medicare through a Medicare Medical Advantage Plan (HMO, PPO) it is likely you will have to follow the plan's steps for approval and purchase of a scooter. For expert, in store advice with you.r power mobility scooter questions, please contact Tim Stiles at Preston Pharmacy