Manual Wheelchair

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 Manual Wheelchair Coverage

 

 Ohio Medicaid:

 

A manual wheelchair may be covered if:

 

  • The patient would be otherwise confined to stationary position for all but very brief periods of ambulation. They are covered in the home.  In a long term care facility, only wheelchairs with custom seating are covered

 

  • Chairs for children under the age of 1 year will not be approved.

 

  • Chairs for leisure or recreational activities are not considered medically necessary and will not be approved.

 

  • Documentation: A one page CMN is required for standard wheelchairs (a six page CMN is required for powered mobility or any W/C with custom seating) with no seating. Prior authorization is not required for short-term rentals (up to 4 months) of standard, standard hemi and lightweight wheelchairs.  Prior authorization is required for other manual wheelchairs, long term rentals and any wheelchairs.

 

 

    Medicare:

 

A manual wheelchair may be covered if:

 

  • The beneficiary has a mobility limitation that significantly impairs his/her abilities to participate in one or more Mobility Related Activities of Daily Living (MRADL’s) in the home (toileting, feeding, dressing, grooming and bathing).  A mobility limitation is one that prevents one from accomplishing MRADL's, or causes a heightened risk of illness/injury or death secondary to the attempts to participate in MRADL's, or prevents one from completing MRADL's within a reasonable time frame.  In addition, equipment may be covered if other conditions limit the ability to participate in MRADL's (e.g., impaired cognition or vision).

 

  • The beneficiary/caregiver is able to use the equipment safely.

 

  • A walker or cane is not sufficient.

 

  • The home environment must be able to support the use of the equipment.

 

  • Physician chart notes and/or a PT/OT assessment documents: The beneficiary’s medical history including use of other equipment, mobility limitations and ability to operate equipment, mobility limitations and ability to operate equipment safely must be documented.

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