Wheelchairs have coverage rules that surprise most clinicians. First, they are considered to be a "mobility device." While the patient is permitted to use it outside, coverage can only stem from what happens in the house.
Further, for the item to be covered, the patient must have a problem completing one or more of the "MRADLs." These are: Toileting, Feeding, Bathing, Grooming, and Dressing. They can either be unable to complete it, unable to complete it in the customary area of the home, or unable to complete it in a reasonable amount of time.
Order Form (DWO)
Every order requires a written prescription. While prescriptions take many forms, DME prescriptions require several specific elements. Make sure to see the section on "Order Form (DWO)."
Face to Face Examination
For virtually all medical equipment that is used in the home, the patient needs to have a "Face to Face" examination. This simply means that the patient was seen and examined/treated for a condition that is related to the need for the item. Consider a simple example of a hospital admission for a broken leg. there is likely already a history and physical that discusses the examination of the broken leg. If so - this step is done!
Just about every piece of Medical equipment has coverage rules. These rules stem from Federal Law and dictate when an item is covered.
The items mentioned in the coverage rule need to be addressed by a clinician in the patient's chart notes. For example, when a patient needs a wheelchair, the doctor needs to determine that a cane or walker will not work. While he would usually just this mentally - now he needs to chart it.