Medicare Criteria for Electric Wheelchairs (HCPCS Code K0011)

An electric wheelchair is usually covered when the following criteria are met: The patient's condition is such that without the use of a wheelchair would be bed or chair confined. The patient's condition is such that a wheelchair is medically necessary and the patient is unable to operate a wheelchair manually. The patient is capable of safely operating the controls for the power wheelchair. The patient requires the use of a wheelchair to move around in their residence. The patient has severe weakness of the upper extremities due to a neurological, muscular, or cardiopulmonary disease or condition. The patient’s condition is such that a power wheelchair will be needed long term (6 months+). Because part of Medicare criteria is that the patient be unable to operate a manual wheelchair, if Medicare has previously covered the rental of a manual wheelchair, the manual wheelchair must be returned to the company that supplied it before Medicare will cover the cost of an electric wheelchair. If you are banking on the fact that you will be reimbursed by Medicare, but you want a little extra assurance before you purchase the scooter or electric wheelchair, you can file for pre-approval from Medicare. However, Medicare states that "if the review personnel make an "authorized" decision, this does not guarantee payment by Medicare for the product. An "authorized" determination is confirmation that the patients condition as described meets the criteria defined in the DMERC medical policies for the specified item."

Medicare Criteria for Scooters (HCPCS Code E1230) 

To be considered medically necessary, the following coverage criteria must all be met: 
The patient is unable to operate a manual wheelchair. The patient is capable of safely operating the controls for the scooter. The patient can transfer safely in and out of the scooter, and have adequate trunk stability for safety. The patient's condition must be such that a POV is required for the patient to get around in his or her residence. A POV that is beneficial primarily in allowing the patient to perform leisure or recreational activities will be denied as not medically necessary. These are some of the economy scooters that qualify for Medicare.



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