How To Qualify?
The guidelines to complete a Medicare assessment for a power mobility device (PMD) includes the following:
1. Physician’s notes to clearly indicate that PRIMARY reason for patient visit is a mobility examination.
2. Findings must be documented in a detailed narrative in physician’s standard note format which is used for all other physician notes (can’t use forms from vendors).
3. Assessment notes must include 7 element order: patient name, date of birth, description of equipment ordered, diagnosis codes, length of need, date of face-to-face evaluation, physician name/signature, date of physician signature
4. Before equipment is delivered, doctor needs to sign a detailed prescription which includes all billable codes.
5. Physician script must be dated on same day or after the date when doctor completes mobility evaluation.
A physician mobility assessment must include:
1. History of present condition and relevant past medical history
• Symptoms that limit ambulation
• Diagnoses responsible for symptoms
• Medications or other treatment for symptoms
• Progression of ambulation difficulty over time
• Distance patient can walk without stopping
• Pace of ambulation
• What has changed to now require a PMD
• Ability to use a manual wheelchair
• Other diagnoses that may relate to ambulatory problems or ability to use a walker or manual wheelchair
• History of falls, including frequency, circumstances leading to falls, and why a walker isn’t sufficient.
• What ambulatory assistance (cane, walker, wheelchair) is currently used and why it isn’t sufficient?
• How does the condition interfere with the patients ability to perform ADLs (activities of daily living) in the home and what ADLs are effected?
2. Physical examination relevant to mobility needs
• Height and weight
• Arm and leg strength and range of motion
• Neurological examination
• Balance and coordination
NOTE: Physician may refer patient to a licensed/certified medical professional (LCMP), such as a physical therapist (PT) or occupational therapist (OT), with experience and training in mobility evaluations, to perform part of the face-to-face examination. Physician reviews a written report of this examination and performs additional examinations needed. Report of physician’s visit shall state concurrence or disagreement with the LCMP examination. PT/OT evaluation does NOT replace physician’s involvement. It is the responsibility of treating physician to establish medical necessity in their usual record keeping format in the patient’s medical record.
NOTE: For Medicare to cover a PMD, supplier must obtain a written order within 45 days of a face-to-face exam by treating physician prior to delivery. A PMD cannot be delivered per a verbal order. If written order is not obtained prior to delivery, payment will not be made even if a written order is subsequently obtained.
Some mobility vendors or providers may offer physicians Medicare mobility forms NOT approved by CMS. If you receive such a form, please know that even if a physician completes this form and puts it in a patient’s chart, these forms are not an acceptable substitute for the patient’s comprehensive medical record. Contact us to obtain a Medicare-approved form.
Information CMS may require, such as notes from prior patient visits, test results, etc. is NOT A SUBSTITUTE for a face-to-face evaluation. Although additional information is needed to provide a historical perspective of a patient’s condition in the continuum of care, corroborating the information in the face-to-face examination is vital to indicate a patient’s condition and progression of disease over time.