Medicare Coverage of Wheelchairs & Scooters: What You Need to Know

Who Should Read This

This publication is essential reading for Medicare beneficiaries of any age who have a health condition that limits their ability to move around inside their home. It is especially relevant for adults 65 and older, as well as younger people enrolled in Medicare due to a qualifying disability.

Caregivers, family members, and adult children helping a loved one navigate Medicare will also find this publication valuable. If someone you care for is struggling with daily activities - like bathing, dressing, or getting in and out of bed - this guide explains what Medicare may cover to help restore independence and safety at home.

Quick Overview

This two-page fact sheet from the Centers for Medicare & Medicaid Services (CMS) explains when Medicare Part B covers power-operated scooters and wheelchairs as durable medical equipment (DME). It outlines who qualifies, what types of devices are covered, how prior authorization works, and what to do if a request is denied or fraud is suspected.

The publication covers three main topics: eligibility requirements for coverage, the different types of mobility equipment Medicare recognizes, and the prior authorization process for specific power devices.

The original publication is 7 pages, including detailed prior authorization tables listing specific power wheelchair and scooter model groups.

Key Takeaways

• Medicare Part B covers manual wheelchairs, power wheelchairs, and power scooters as durable medical equipment (DME) when medical need is documented.
• Coverage applies to use in the home - the device must be medically necessary for home use, not simply for convenience or travel.
• A written order from your treating doctor is required, and both the doctor and DME supplier must be enrolled in Medicare.
• After meeting the annual Part B deductible, you pay 20% of the Medicare-approved amount when your supplier accepts assignment.
• A face-to-face exam with your doctor is required before receiving a power wheelchair or scooter.
• Many power wheelchairs and scooters require prior authorization before Medicare will approve payment.
• Be alert to fraud - offers of 'free' equipment, cash incentives, or doctors you don't know ordering devices on your behalf are warning signs.

Publication Summary

Eligibility Requirements

Medicare Part B covers wheelchairs and scooters when specific criteria are met. Your treating doctor must submit a written order confirming a medical need for the device for use in your home. Beyond that, you must have a health condition causing significant difficulty moving around inside your home, and be unable to carry out basic daily activities - such as bathing, dressing, getting in and out of a bed or chair, or using the bathroom - even with the help of a cane, crutch, or walker.

You must also be able to safely operate and get on and off the device, or have a caregiver consistently available to help. Finally, both your treating doctor and your DME supplier must accept Medicare. Your doctor or supplier must also have verified that the equipment can be safely used within your home - for example, confirming that a power wheelchair can fit through your doorways.

What You Pay

After you meet the annual Part B deductible Medicare pays 80% of the Medicare-approved amount and you pay the remaining 20%, provided your DME supplier accepts assignment. Assignment means the supplier agrees to accept what Medicare approves as full payment and cannot bill you beyond your deductible and coinsurance. It is important to confirm that both your doctor and your supplier are enrolled in Medicare before receiving any equipment. Suppliers who do not accept assignment may bill you for the full cost of the equipment.

If you are enrolled in a Medicare Advantage Plan (Part C), contact your plan directly, as costs and approved suppliers may differ from Original Medicare.

Types of Equipment Covered

Medicare recognizes three categories of mobility devices:

• Manual wheelchair: For people who cannot safely use a cane or walker but have sufficient upper body strength, or have someone who can assist them. You may be required to rent a manual wheelchair before purchasing.
• Power-operated scooter: For people who cannot use a cane, walker, or manual wheelchair. To qualify, you must be able to get in and out of the scooter safely and be strong enough to sit upright and operate the controls. Short-term rental is available if long-term use is not anticipated.
• Power wheelchair: For people who cannot use a manual wheelchair in their home, or who do not qualify for a power scooter. A face-to-face exam with your doctor is required before Medicare will approve a power wheelchair.

Prior Authorization

A large number of specific power wheelchair and scooter models require prior authorization - meaning Medicare must approve the request before the equipment is delivered. Your DME supplier will work with your doctor to submit the required documents to Medicare. The publication includes detailed tables listing specific model groups (identified by 'K' codes) across three categories: power wheelchairs with sling or solid seat/back, power wheelchairs with captain's chair seating, and power-operated vehicles (scooters).

These models span standard, heavy-duty, very heavy-duty, and extra heavy-duty weight capacities. If your request is approved, Medicare sends a decision letter to your DME supplier. If denied, your supplier may resubmit with additional information. You also have the right to appeal a denied claim through Medicare's standard appeals process.

Protecting Yourself from Fraud

The publication cautions beneficiaries to be alert to aggressive or dishonest DME suppliers. Warning signs include offers of a 'free' wheelchair or scooter, offers to waive your copayment or pay you cash, or a doctor you have never seen ordering equipment on your behalf. Protecting yourself is straightforward: keep records of your doctor's appointments and any equipment you receive, and review your Medicare Summary Notices for any claims involving equipment you did not receive. Suspected fraud can be reported by calling 1-800-MEDICARE (1-800-633-4227) or online at Medicare.gov.

Frequently Asked Questions

Q: Does Medicare cover a wheelchair if I only need it for going out in public, like shopping or doctor's appointments? A: No. Medicare requires that the wheelchair or scooter be medically necessary for use inside your home. If mobility issues only arise outside the home, Medicare will not cover the device.

Q: Do I need to see my doctor before getting a power wheelchair or scooter? A: Yes. A face-to-face exam with your treating doctor is required before Medicare will cover a power wheelchair or scooter. Your doctor evaluates your needs, determines whether you can safely operate the device, and then submits a written order to Medicare.

Q: What does 'prior authorization' mean, and does it apply to my wheelchair? A: Prior authorization means Medicare must review and approve a request before the equipment is delivered and payment is made. It applies to many specific models of power wheelchairs and scooters listed in the publication. Your DME supplier will handle the submission process in coordination with your doctor.

Q: What happens if my prior authorization request is denied? A: If your request is denied because Medicare needs more information, your DME supplier can resubmit with the additional documentation. If the claim is denied because Medicare determines the equipment is not medically necessary, you have the right to appeal the decision. Visit Medicare.gov/claims-appeals for information on how to file an appeal.

Q: How much will I pay out of pocket for a covered wheelchair? A: After meeting your annual Part B deductible, you are responsible for 20% of the Medicare-approved amount when your supplier accepts assignment. Medicare pays the remaining 80%.

Access the Full Publication

Publication number: CMS Product No. 11046 
Date: April 2024 
Length: 8 pages