CMS UPDATES RULES FOR REPLACEMENTWHEELCHAIRS AFTER 5 YEARS

The new update suggests that a detailed written order, prior to delivery, for an
identical replacement power wheelchairs will satisfy the prior authorization
requirements for Original Medicare.

What does this mean for me??

• Eliminates the requirement for a new face to face evaluation IF your medical need has already been established and your current chair was covered by Original Medicare.
• This allows your physician and therapist to use the justification documentation they used for your current chair can be applied towards your replacement chair, in addition to any documentation that they may have that addresses your continued need for the chair over the time that you’ve had it.
• Basically, if your chair is at least five years old and you need a replacement due to wear and tear, you and your wheelchair provision team may have to provide less paperwork to get a chair and seating systems within the same code sets as your current chair.

Is this approach for my chair replacement right for me?

Things to ask yourself before going this route:

• Have you had any changes to your posture or positioning in the last five years? (i.e.
• scoliosis, kyphosis, weight change)
• Have you had any new pressure injuries?
• Have you had any changes to your medical history or functional ability? (i.e. driving with a joystick feels harder now or decreased strength)
• Would you benefit from any additional power seat functions that you previously
• did not qualify for?
• Does my current drive wheel configuration still work for me?

If the answer is yes to any of these questions, or you are unsure, the recommendation would be to contact your PT/OT for a consultation.
Your primary therapist as well as your wheelchair supplier can help guide you to make the decision that is most appropriate for you.

While this update may help streamline equipment provision for those simply looking to receive a new version of their current equipment, it is your right as the consumer to feel informed in this decision making. Don’t be afraid to ask questions!