Power Mobility Devices – Rentals

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Change of Residence

1. Is it advisable for the supplier to document in their records that they have contacted the beneficiary and confirmed that the beneficiary is able to use the power wheelchair (PWC) they are renting in their new residence?

   • There is no requirement for a supplier to reassess the home in the event that a beneficiary changes residence.

     Originally published: 02.20.17
     Reviewed: 12.06.23

2. If a beneficiary with a PWC moves and their new home will no longer accommodate the PWC that they have, will Medicare pay for a new PWC?

   • No. Medicare covers a replacement only if an item is lost, stolen, irreparably damaged, or reaches the 5-year reasonable useful lifetime. Medicare covers a different item only if there is a change in the beneficiary's medical condition.

     Originally published: 02.20.17
     Reviewed: 12.06.23

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Miscellaneous

1. If the beneficiary weighs 478 pounds and is renting a very heavy-duty PWC coded K0827 prior to a hospitalization and/or skilled nursing facility stay has a significant weight loss taking them below the 300 pounds limit for standard power wheelchairs, would a new rental episode begin upon return to home, for a standard PWC coded K0823?

   • No. If the beneficiary loses weight, the original wheelchair would still meet the beneficiary's needs. If the supplier elects to provide a lower weight capacity PWC, a new CR period would not begin.

     Originally published: 02.20.17
     Reviewed: 12.06.23

2. How will the "look back" period affect the review of PWCs?

   • There is a general policy that the coverage of items provided on an ongoing basis, including rented DME, is dependent on a continued need for the item and continued use by the beneficiary. CMS and the DME MACs have not published any information regarding the look back period.

     Originally published: 02.20.17
     Reviewed: 12.06.23

3. Will elevating leg rests (already a mandatory CR item) be paid at 15% in months 1-3 and 6% in months 4-13, or will they remain at a payment rate of 10% in months 1-3 and 7.5% in months 4-13?

   • Payment policy for accessories is not changing.

     Originally published: 02.20.17
     Reviewed: 12.06.23

4. If payment for separately billable items at initial issue will be at the front loaded rate, how will these items be distinguished as receiving a different payment methodology from the same items (other than batteries) on a manual wheelchair?

   • Payment policy for accessories is not changing.

     Originally published: 02.20.17
     Reviewed: 12.06.23

5. Will a "patient requested upgrade" from a Group 2 power wheelchair (K0822 - K0831) to a Group 3 power wheelchair base (K0848 - K0855) retain the option to purchase the chair in the first month?

   • No, the application of upgrade provisions does not change the payment rules for any item.

     Originally published: 02.20.17
     Reviewed: 12.06.23

6. Is there a requirement mandating that contact with the beneficiary must be made at certain intervals to determine if a PMD meets the ongoing use requirement?
   • Continued use requirements must be met during the wheelchair rental period as outlined in the Standard Documentation Requirements (SDR) for All Claims Submitted to the DME MACs (A55426). No monitoring of purchased items or capped rental items that have converted to a purchase is required. Suppliers must discontinue billing Medicare when rental items are no longer being used by the beneficiary. Beneficiary medical records or supplier records may be used to confirm that a DMEPOS item continues to be used by the beneficiary as outlined in the SDR. Timely documentation is defined as a record in the preceding 12 months unless otherwise specified.

     Originally published: 02.20.17
     Reviewed: 12.06.23

7. If a treating practitioner's order documents lifetime medical necessity for a PMD, must the treating practitioner's medical record indicate that the beneficiary has been seen during the 13-month period and document that ongoing medical necessity is met?

   • Continued medical need requirements must be met during the wheelchair rental period as outlined in the Standard Documentation Requirements (SDR) for All Claims Submitted to the DME MACs (A55426). For rented DME items, there must be information in the beneficiary’s medical record to support that the item continues to remain reasonable and necessary as outlined in the SDR. Information used to justify continued medical need must be timely for the DOS under review. Timely documentation is defined as a record in the preceding 12 months unless otherwise specified.

     Originally published: 02.20.17
     Reviewed: 12.06.23

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Repair/Replacement

1. If, during a CR period, a PWC is lost, stolen, or irreparably damaged and a new PWC is provided, does a new CR period start?

   • Yes. Replacement of power wheelchairs will follow the same rules as any other rented DME item.

     Originally published: 02.20.17
     Reviewed: 12.06.23

2. Medicare provides for the replacement of lost, stolen, or irreparably damaged items, but we are concerned as to how this fits with Supplier Standard # (14), which states: "Must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries. The item must function as required and intended after being repaired or replaced." Can you please clarify, as this is a significant concern for providers and beneficiaries?

   • The Supplier Standards address situations related to non-function or damage of an item that can be repaired or to replacement of an item due to wear and tear. Lost, stolen, or irreparably damaged items are a different category.

     The Medicare Benefit Policy Manual, Chapter 15, Section 110.2(A) states:

     "Since renters of equipment recover from the rental charge the expenses they incur in maintaining in working order the equipment they rent out, separately itemized charges for repair of rented equipment are not covered. This includes items in the frequent and substantial servicing, oxygen equipment, capped rental and inexpensive or routinely purchased payment categories which are being rented."

     The Medicare Benefit Policy Manual, Chapter 15, Section 110.2(C) defines payment policy for items that are lost or that have been irreparably damaged by an acute incident:

     "Equipment which the beneficiary owns or is a capped rental item may be replaced in cases of loss or irreparable damage. Irreparable damage refers to a specific accident or to a natural disaster (e.g., fire, flood)."

     "Irreparable wear refers to deterioration sustained from day-to-day usage over time and a specific event cannot be identified. Replacement of equipment due to irreparable wear takes into consideration the reasonable useful lifetime of the equipment." (This means that replacement due to wear and tear is possible only after the 5-year reasonable useful lifetime.)

     Originally published: 02.20.17
     Reviewed: 12.06.23

3. Is there any situation in which a supplier can be paid for repair to a PWC during a capped period? For example, if the supplier has information to indicate that the repair is required due to "malicious damage" or "culpable neglect" by the beneficiary, then is the repair payable even though it was performed during the capped rental period?

   • There can be no payment for the repair of rented items under any circumstances. Reimbursement for repairs is included in the rental payments.

     If the supplier believes that a wheelchair repair is required because of malicious damage or culpable neglect by the beneficiary, the supplier can present the information to the DME MAC for investigation. If the DME MAC, in consultation with the CMS, agrees that the beneficiary is responsible for the damage, the supplier can charge the beneficiary.

     Originally published: 02.20.17
     Reviewed: 12.06.23

4. How does a supplier alert the DME MAC that they believe the PWC requires a repair secondary to malicious damage or culpable neglect?

   • The supplier can contact the provider customer service department. That staff will forward the information to the appropriate DME MAC staff.

     Originally published: 02.20.17
     Reviewed: 12.06.23

5. Who is responsible for determining when a beneficiary is responsible for the damage, and how will this be communicated?

   • As discussed in a previous question, the DME MAC will consult with CMS to make that determination. Since these are very rare situations, there is no established procedure. These situations will be handled on an individual basis.

     Originally published: 02.20.17
     Reviewed: 12.06.23

6. If a PWC is damaged outside the home, since that is not an approved use per Medicare, will the supplier be expected to repair the chair "at no charge" during the rental period?

   • Yes, the supplier is responsible for the repair. Statutory coverage of DME requires that it be needed for use inside the home. However, if that requirement is met, the item may be used outside the home. Portable oxygen, nebulizers, walkers, canes, crutches, POVs, manual and power wheelchairs are among the many items, both rental and purchase, that are routinely used outside of the home setting. During the rental period, the supplier is expected to repair an item if the repair was related to damage that occurred either inside or outside the home. For purchased and rental items where the title has transferred, repairs are covered under the general repair rules.

     Originally published: 02.20.17
     Reviewed: 12.06.23

7. How would a supplier prove the damage occurred outside the home (unless it is obvious, like sand/mud/water in the motor)?

   • Use of a DME item outside of the home is not deemed evidence of deliberate malicious damage or culpable neglect.

     Originally published: 02.20.17
     Reviewed: 12.06.23

8. If the beneficiary has a power chair under rental and the power chair has a service/repair issue, is it permissible to provide the beneficiary with a loaner manual wheelchair while the power wheelchair is being repaired, or is the supplier required to replace the power wheelchair?

   • The supplier is required to provide a loaner item that meets the beneficiary's medical need.

     Originally published: 02.20.17
     Reviewed: 12.06.23

9. While the beneficiary's rental power wheelchair is being repaired, does monthly billing for the power wheelchair continue?

   • Yes, monthly billing for the power wheelchair continues. There should be no separate billing and/or payment for the loaner wheelchair during the 13-month CR period.

     Originally published: 02.20.17
     Reviewed: 12.06.23

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Short-term Use

1. When standard PWCs are provided on a rental basis, can they be covered for short-term indications?

   • No. The change in the payment policy status for power wheelchair does not change the policy statement that PWCs are not covered for beneficiaries with short-term, reversible conditions.

     Originally published: 02.20.17
     Reviewed: 12.06.23

2. A short-term rental would occur if the beneficiary were to pass away in the second month of the rental period. Will a short duration in billing signal that a short-term rental has occurred and flag the claim for review?

   • If all the criteria are met for coverage of a PWC and the initial rental months are paid but the beneficiary dies within the first three months, or the beneficiary goes into a nursing home on a permanent basis during the first three months, that does not affect coverage of those initially paid rental months.

     Originally published: 02.20.17
     Reviewed: 12.06.23

Additional Resources

• Power Mobility Devices LCD
• Power Mobility Devices PA
• Medicare Benefit Policy Manual
• Power Mobility Devices Weight Requirements Tool
• Prior Authorization
• Documentation Checklists
• Prior Authorization - HCPCS Code Lookup

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