Home assessment authorization requirements for Power Mobility Devices and Manual Wheelchairs

www.MercyCareAZ.org

June 29, 2020

Applicable to: Mercy Care Complete Care, Mercy Care Long Term Care, Mercy Care DD, Mercy Care RBHA and Mercy Care Advantage

For Power Mobility Devices (Group 1, 2, 3, 4 and 5) and manual wheelchairs the CMS criteria, amongst other requirements, indicates that the supplier or practitioner must perform an on-site evaluation of the beneficiary’s home or indirectly based upon information provided by the beneficiary or their designee. This will verify that the beneficiary can adequately maneuver the device that is provided considering the physical layout, doorway width, doorway thresholds, and surfaces.

There must be a written report of this evaluation available on request for Power Mobility Devices used inside the home. If the documentation of home evaluation is not present at the time of prior authorization, then this documentation will be required at the time of the claim submission. A review of records will be performed again, and if it does not meet the required criteria or if the documentation of home evaluation is not provided, the claim will be denied.

This is based on CMS Local Coverage Criteria for Power Mobility Devices .

As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website .

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