Point Person: Medical Records Team (Carolyn Lawrence)

Motorized/power wheelchairs can be ordered for patients who have physical impairments limiting their ability to maneuver a manual chair.

See also DME for Manual Wheelchairs.

Eligibility

• All Insurance: Pays for power chairs when required for mobility INSIDE the home, getting from room to room, getting to the bathroom, etc.
  • Medicare does not pay for chairs when someone is able to navigate within the home but needs assistance for longer distances OUTSIDE the home. Patients will generally need to pay for these themselves.
  • Don’t call the order a “scooter”, since scooters are generally not covered items, just electric power wheelchairs. Instead, call it a “power wheelchair” or “power chair”.

Initial Order

1. Place an order for “Ambulatory Referral to Physical Therapy” and select “OT Wheelchair Evaluation” (usually with Laura Juel).
   • This will allow the patient to be scheduled specifically into the wheelchair OT clinic where they assess the need and have sample chairs to trial. The note from this visit will state the specific chair and accessories they recommend.
2. Schedule a face-to-face appointment with MD after the OT visit. Include “Encounter for power mobility device assessment [Z76.89]” in the visit diagnoses. Use the smartphrase .F2FPOWER to document the need for motorized wheelchair.
   • An appointment must occur face-to-face or via video visit. Telephone visit is not acceptable. This can occur before the OT visit; however, the 45-day clock for the order starts on the day of this MD visit, so this is often scheduled after the OT visit.
3. Place an order for “Wheelchair – Motorized”. Print the order and place in the Medical Records bin.
   • Click here for a tip sheet on reprinting medical supply orders [PDF].
4. Route the chart to “P DUKE OUTPATIENT CLINIC – MPDC MEDICAL RECORDS” with a note that you have placed the orders for a power chair to get assistance in faxing to supply companies.
5. Complete the CMN or 7-element paperwork form (provided by the company) and OT note.
   • The same attending who staffed the face-to-face visit must sign/co-sign both of these notes within 45 days. Carolyn Lawrence will route these to the correct attending and fax these back to the vendor within 45 days of the face-to-face visit.

Repairs

1. Place an order for “Generic Supply Order” of type GSE where the Generic Supply Name is “Motorized wheelchair repair”.
2. Document the reason for the power wheelchair repair in a note.
3. Route the chart to “P DUKE OUTPATIENT CLINIC – MPDC MEDICAL RECORDS” with a note that you have placed the orders for a power chair repair to get assistance in faxing to supply companies.
4. If the insurer is Medicare, an attending may need to sign any paper forms that come through.

Replacement

Medicare/Medicaid/Insurance will generally replace mobility devices and large devices (CPAP/BiPAP) every 5 years. It is very difficult to get a replacement sooner.

1. Follow the steps for initial ordering as above, with the following modification for the clinic note:
   1. Use the smartphrase .F2FREPLACEMENT to document the need for wheelchair replacement.
   2. If the mobility device is less than 5 years old and in need of replacement, the visit note must document why the current device is not meeting their needs, for example, that the absence of the device is negatively affecting the patient’s health status.
2. If the insurer is Medicare, an attending may need to sign any paper forms that come through.