Medicare Billing for Manual Wheelchairs

If you're in need of a manual wheelchair but you are not sure if you are covered by Medicare, then you've come to the right place. Atlantic Healthcare Products is experienced in Medicare billing for manual wheelchairs. We'll take care of all the paperwork and make sure that Medicare's coverage criteria is met. We work closely with patients, doctors, and Medicare to make sure that everything goes smoothly. We're proud to serve Palm Beach County and beyond. So whether you need a manual wheelchair for yourself or a loved one, we can help. Give us a call today.

Criteria and Medical Justification must be met for coverage.

Save time by filling out our basic patient information form. All we need is patient name, date of birth, contact information, address, insurance information and a brief description of what you are looking for.  Once we receive your information, we will get the process started before you get to the store.  Click on Get Pre-Qualified to get started.

 The checklist below is derived from Medicare’s Coverage criteria for a Manual Wheelchair. Without the below criteria being fully and legible documented in the physician's chart notes and Rx, Medical justification has not been met. 

Checklist for Face-to-Face Examination Chart Notes for a Manual Wheelchair

Criteria for F2F Chart Notes for Manual Wheelchair - K0001 

 

▢  Is the Reason for the face-to-face encounter conducted by the physician, to evaluate and/or treat the condition that supports the item(s) of DME ordered.  –(“follow-up” is not acceptable) 

▢  Is there a description of how the diagnosis limits the patient’s condition. 

▢  Is there an indication that the beneficiary meets ALL below criteria:  

▢  The beneficiary has a mobility limitation that impairs their ability to participate in  MRADL’s in the home?  (MRADL’s: toileting, feeding, dressing, grooming, and bathing)  

▢  (Mobility Limitation: Prevents, or puts oneself at risk or cannot complete MRADLS Timely fashion)  - AND -  

▢  The mobility limitation cannot be resolved by the use of an appropriately fitted cane or walker.  - AND - 

▢  The beneficiary’s home provides adequate access between rooms, maneuvering space, and surfaces for use of the Manual Wheelchair.   - AND - 

▢  A manual wheelchair will improve the beneficiary’s ability to participate in MRADLs in the home. Does the beneficiary have a willingness to use the manual wheelchair in the home?    - AND - 

There is a caregiver who is available, willing, and able to provide assistance with the wheelchair. If yes, indicate Name and Relation of caregiver - OR -  Does the beneficiary have sufficient upper extremity function and physical and mental capabilities needed to self-propel the manual wheelchair? 

▢  Option for high Strength Lightweight Wheelchair -  K0004   

▢  The member self‐propels the wheelchair while engaging in frequent activities in the home that cannot be performed in a standard or lightweight wheelchair. (and/or) 

▢  The member requires a seat width, depth, or height that cannot be accommodated in a standard, lightweight, or hemi‐wheelchair, and spends at least two hours per day in the wheelchair. 

▢  Note: A high strength lightweight wheelchair is rarely medically necessary if the expected duration of need is less than three months (e.g., postoperative recovery).   

 ▢  Option for Reclining Back Wheelchair–  

▢  In addition to above, the beneficiary is at high risk for development of a pressure ulcer and is unable to perform a functional weight shift; or 2) utilizes intermittent catheterization for bladder management and is unable to independently transfer from the wheelchair to the bed. 

▢  Option for Elevating Leg Rests–  

▢  Does the beneficiary have a musculoskeletal condition or the presence of a cast or brace which prevents 90 degree flexion at the knee OR 

▢  Significant edema of the feet or legs  that requires an elevating leg rest OR 

▢  Meets the criteria for and has a reclining back on the wheelchair. 

▢  Option for Adjustable Armrest-  

▢  Does the beneficiary require an arm height that is different than those available using non adjustable arms?  Why? 

▢  Number of hours the beneficiary spend per day in the wheelchair 

Additional Safety Features Indicated 

▢  Anti Tippers 

▢  Brake Extensions 

▢  Heel Loops Seat Belt    

Detailed Written Order-  

▢  beneficiary's name,  

▢  item of DME ordered, 

▢  the prescribing practitioner's National Provider Identifier (NPI),  

▢  signature of the ordering practitioner and   

▢  date of the order. 

▢  Is the Detailed written order dated after the F2F, but not more than 6 months old

We offer K0001 Wheelchairs 

     Seat Widths: 18” or  20”

     Overall Width: 26.5”, 28.5”

     Weight Capacity: 250 lbs

     Item Weight: 41 lbs, 43 lbs 

 

Or Upgrade to a K0004 Transformer Wheelchair 

     Seat Widths: 18” or  20” 

     Overall Width: 26.5”, 28.5” 

     Weight Capacity: 250 lbs 

     Item Weight: 31 lbs, 33 lbs 

     Without Wheel: 21 lbs, 23 lbs  

Upgrade is the Fee Schedule difference: $25/month for 13 months 

 Please fax your referrals and documentation to 561-290-1434 

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Need a Manual Wheelchair Today?

We have manual wheelchairs available to purchase or rent.  We have a variety of Manual Wheelchairs to Purchase, look online or visit one of our locations . If you are not ready to purchase, not sure if this is the right medical equipment for you, or just need it for a short period of time, we also have Rental Manual Wheelchairs available.  

How do I get a Manual Wheelchair through Medicare?

DME, or durable medical equipment, can be essential for those with mobility issues. Medicare will often cover the cost of DME, but the process of billing can be complex. At Atlantic Healthcare Products, we have experience with Medicare billing for manual wheelchairs. We will work with you, your doctor, and Medicare to make sure that all coverage criteria are met. We can also deliver the wheelchair directly to your home in Eastern Palm Beach County. Contact us today to learn more about how we can help you get the DME you need.

We can be reached by chat, phone or just visit us at one of locations.

West Palm Beach: 561-964-6767

Boynton Beach: 561-733-2331