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Medicares Wheelchair Scooter Benefit The doctor treating your condition submits a written order stating that you have a medical need for a wheelchair or scooter for use in your home. You pay 20% of the Medicare-approved amount, after you pay your Part B deductible for the year. Medicare pays the other 80%.
Qualifying Diagnoses for Wheelchairs Multiple Sclerosis (MS) ALS (AKA Lou Gehrigs Disease) Parkinsons Disease. Spinal Cord Injuries. Cerebral Palsy. Muscular Dystrophy. CVA (AKA stroke-related paralysis) Post-Polio Syndrome.
The process of getting a custom power wheelchair can take 30-60 days. Usually, your ALS clinic team will let you know when they think you should get started. You can also initiate the process by talking to your neurologist, physical therapist (PT), or occupational therapist (OT).
Medicare only covers one wheelchair or scooter at a time. Medicare only covers a wheelchair or scooter replacement once every five years except in limited circumstances. Medicare covers wheelchair and scooter repairs.
Spinal Cord Injuries. Cerebral Palsy. Muscular Dystrophy. CVA (AKA stroke-related paralysis)
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You should have a decision from the DME MAC around 10 days after you apply. If Medicare doesnt approve your purchase, you have the right to appeal that decision. You or your medical equipment provider can explain in more detail why you need the device to function in your home.
What can I expect during the wheelchair evaluation? The evaluation will take approximately 2 hours. The physical or occupational therapist will be present at the time of the evaluation, along with a representative from a wheelchair company to assist in identifying the most appropriate equipment for you.
Your provider or supplier must send the prior authorization request to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC). The DME MAC will respond within 10 business days (sooner if your health would be harmed by going without equipment), either approving or denying your request.
Spinal Cord Injuries. Cerebral Palsy. Muscular Dystrophy. CVA (AKA stroke-related paralysis)
Medicare helps cover DME if: The doctor treating your condition submits a written order stating that you have a medical need for a wheelchair or scooter for use in your home. You pay 20% of the Medicare-approved amount, after you pay your Part B deductible for the year. Medicare pays the other 80%.

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