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.
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