With Dr. William DeMayo, MD.
Power Mobility Equipment - Medicare and Insurance Coverage
How to go About Making the Right Purchase Decision 
 ​by Dr. William DeMayo, MD
     ​   The subject of payment for Power Mobility has been a volatile issue over the past two decades. Much of our current ordering process has been developed in response to enormous problems with abuse/fraud over the years. A full discussion of that abuse is beyond the scope of this article, but I will refer the reader to following:             o “Press reports and government investigations have uncovered widespread abuse in power wheelchair prescriptions reimbursed                       by Medicare, with specific targeting of minority neighborhoods for aggressive marketing.”              o “Since 1999, Medicare has spent $8.2 billion to procure power wheelchairs and “scooters” for 2.7 million people.  Today, the                                government cannot even guess at how much of that money was paid out to scammers.”
  • The Scooter Store, LTD. (Wikipedia)
            o Founded 1990, 2008 revenue $332 million
            o On February 20, 2013, Federal agents with search warrants raided the Scooter Store's New Braunfels, Texas headquarters.                                 According to various news sources, the FBI agents were there to investigate the company's billing practices. Company                                       spokespeople declined to comment to the press. The company entered liquidation and terminated remaining employees on 
               September 13, 2013 Unfortunately, companies like The Scooter Store and their widespread commercials have led to a public 
               perception that power mobility is easily funded by insurance. The resultant overutilization and abuse/fraud has led to Medicare
               having requirements for extensive documentation regarding the functional need for power mobility. Most insurers follow
               Medicare guidelines. To make things even more complicated, many physicians are not aware of current documentation
               requirements and, when wheelchairs are denied, they may communicate inaccurate information regarding eligibility criteria. I
               would highly advise any reader interested in power mobility to seek out a consultation with a Physical Medicine and
               Rehabilitation specialist (Physiatrist) who regularly prescribes power mobility (the physician finder tool at AAPMR.org may be
               helpful). In addition to being sure that documentation guidelines are met, the Physiatrist will be able to provide valuable input
               regarding specific needs and options. I also highly encourage individuals interested in power mobility to be educated regarding
               the guidelines so that they can appropriately advocate for themselves. The September, 2016 Medicare document “Power Mobility
               Device Documentation and Coverage Requirements” provides an excellent outline of guidelines.   HERE
               *Please note that Medicare documentation prior to 2016 may not be accurate.   
     Significant points in this document include the following (my Bold and underlining were added for emphasis with subsequent explanatory note):
  • Power Mobility Devices (PMDs) are covered under Medicare part B Durable Medical Equipment (DME) benefits and include:
          ​ • Power Operated Vehicles (POVs)-also known as scooters.
           • Power Wheelchairs (PWCs).
  •  Power mobility devices are covered for use in the home.
            •   Note: nothing prohibits using the device outside of the home however, it is the necessity in the home that meets the eligibility
                criteria. An individual can move about the home functionally without a power mobility device then they are not eligible
                regardless of opportunities device might provide outside the home.
  • A Mobility-Related Activity of Daily Living (MRADL) limitation must be documented within the home which is not sufficiently or safely resolved by using an appropriate fitting cane or walker.
          • Note: it is essential to differentiate potential mobility from reliable/safe mobility.   As an example, an individual may be able to walk
            from the living room to the kitchen or bathroom at times yet other times pain/stiffness/fatigue may preclude this activity or make
            it unsafe. This individual may meet the criteria.
  • The individual must demonstrate mental capabilities and physical capabilities sufficient for safe operation of the device in the home and using the device must significantly improve ability to participate in MRADLs (Mobility Related Activity to Daily Living such as toileting, feeding, dressing, grooming, and bathing) to a degree that cannot be obtained using other MAE (Mobility Assistive Equipment such as a cane, crutch, walker, or manual wheelchair).
            •   Note:   I work with vendors that routinely bring a demonstration wheelchair to the home and documented this ability as part of
              the ordering process. They do an awesome job evaluating beforehand and predetermine the likely best wheelchair. It is always a
             loaner and temporary while the final wheelchair is ordered. Some vendors bring chairs as a pressure tactic. If they bring a piece of
             equipment to your home that you feel isn’t correct, please don’t hesitate talking to the company who delivered it. If that doesn’t
             solve the issue – contact your physician. Don’t be pressured into something that isn’t right.
  •  For scooters, the individual must also show they can maintain postural stability and position while operating the tiller steering   system (a power wheelchair typically has a joystick located on or about the armrest rather than the tiller in front).
           • Note: Given the new functional requirements, I find that it is rare for me to order scooters through insurance. In addition to the
             need for the patient to have good trunk strength, the turning radius of scooters is very poor and require significant space in the
             home. Also, the captain’s chair of the scooter is not customizable and does not lend itself to use throughout the day without
             resulting in other problems such as back pain. It is particularly poor for individuals with scoliosis.
     In general, power wheelchairs are the most appropriate for inside the home ​and scooters are more helpful outside of the home
(or for episodic use). 
This article has been abbreviated. 
​The full article (along with many others) is available in the Articles Section of DeMayo's Q&A Clinic.
Note:  This article is available in PDF format for easy download, on Dr. DeMayo's "articles" page - HERE
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                       A Message from Dr. DeMayo:
              In general, access for individuals with  
        disabilities is very difficult here in the UAE. 
  Even so, I saw this and I thought very determined
              Polio Survivors might enjoy it.
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