covers power-operated vehicles (scooters) and manual wheelchairs as durable medical equipment (DME) that your doctor prescribes for use in your home.
You must have a face-to-face examination and a written prescription from a doctor or other treating provider before Medicare helps pay for a power wheelchair. Part B covers power wheelchairs only when they're
Starting September 1, 2018, you may have to get prior approval (known as “prior authorization”) for certain types of power wheelchairs. Under this program, 40 types of power wheelchairs require “prior authorization” before Medicare will cover the wheelchair cost.
Your DME supplier will need to:
- Request “prior authorization”
- Send the request and required documents to Medicare
You don’t need to do anything. If your physician prescribes one of these wheelchairs to you, your DME supplier will, in most cases, submit a prior authorization request and all documentation to Medicare on your behalf. Medicare will review the information to make sure that you’re eligible and meet all requirements for power wheelchair coverage. Your Medicare coverage and benefits will stay the same, and you shouldn’t experience delays getting the items you need.
Your prior authorization request may be denied if:
- Medicare finds you don’t medically require a power wheelchair
- Medicare doesn’t get all the information needed to make a decision
If additional information is needed, your DME supplier may resubmit your prior authorization request.
For more information, call us at 1-800-MEDICARE.