Patient may be a candidate for a wheelchair if at least one of the following conditions apply:
- Patient has difficulty with mobility in the home such as getting to the bathroom in time before an incontinent episode; or
- Patient cannot walk safely (without falls/near falls) throughout the home independently (with or without an assistive device such as
a cane or walker) and do so in a reasonable amount of time
If conditional, documentation is needed for the medical reasons for these limitations (pain, weakness, sensory issues, etc). In some cases, Medicare requires a "Face to Face Evaluation" and document these conditions in a clinical setting for the purpose of determining need for a mobility device. This documentation should be done in your usual form of documentation and not on a letterhead provided by a Durable Medical Equipment (DME) provider.
General Recommendation: Evaluation* and documentation in collaboration with a certified assistive technology professional at the nearest health system or hospital-based outpatient facility or clinic (search here) who can advise on considerations of insurance stipulations, assistive technologies, wheelchair selection, vendor selection, wheelchair fitting, and seating evaluation.
Note
*Some insurance will require an evaluation by a licensed PT or OT. Some therapists may be comfortable performing these evaluations but others may not and can help with referring to a qualified therapist to do a thorough evaluation.
