How to Qualify for a Mobility Scooter: A Comprehensive Guide

Requirements for Mobility Scooters

• Medicare Requirements

Let’s chew the fat about Medicare coverage for personal mobility devices (PMDs). They’ll only foot the bill if you’re in a real pickle. However, you’ve got to check these three boxes:

• The patient is unable to handle Mobility-Related Activities of Daily Living (MRADLs). If you’re struggling with things like hitting the bathroom, getting dressed, or feeding yourself, then you’re well on your way to meeting their criteria.
• A cane or walker isn’t adequate for providing reliable and adequate support.
• The patient is unable to utilize a standard wheelchair due to incapacity or weakness in the upper body.

Healthcare Provider Requirements

Healthcare providers also have a big job on their hands. They’re the ones in the hot seat, tasked with prescribing mobility scooters or powerchairs to folks who need them for everyday tasks around the house.

For people who are all out of gas when it comes to upper body strength, these little motorized vehicles can be a real game changer, giving them the freedom to get around with ease.

Furthermore, these PMDs are mainly for use inside your home. That means they need to be able to zip through your home’s doorways and entrances without a hitch.

Now, the Centers for Medicare and Medicaid Services have laid down some specific requirements that your healthcare provider needs to stick to. These include:

• A face-to-face meeting with the patient to figure out whether or not a PMD is medically necessary.
• A copy of the examination records. You’re going to need a copy of your medical exam records and the prescription for your scooter. All these documents need to be sent to the supplier. And if there’s extra medical paperwork to back up your need for a Personal Mobility Device, throw that in too. Just remember to stick to the clock: all this paperwork needs to reach the PMD supplier within 45 days of your in-person medical check-up.
• For the face-to-face checkup, you’ll need a bill with the right evaluation and management code. That’s not all.  You’ll also need extra bills with the proper codes to account for the extra time spent doing the exam and getting the documentation to the PMD supplier.

Assessment of Your Medical Needs

During your in-person consultation with a doctor, you’ll answer specific questions. Here are some questions you or your caretaker will need to answer:

• Describe the mobility issue you have and how it impacts your everyday life.
• If you require help getting around, why can’t a cane or walker suffice?
• Why can’t you use a manual wheelchair to get around?
• Can you securely use the PMD in your house, including getting on and off of it?
• Can you handle PMD on your own, both physically and mentally?

Out-of-Pocket Purchase

Some folks might find a PMD a real boon, but they don’t quite fit into the strict medical necessity guidelines to get one through Medicare. But don’t get your feathers ruffled. There’s no rule saying you can’t buy a mobility scooter straight from a supplier if you’re ready to pay out-of-pocket; no insurance backing is needed.

Plenty of suppliers, both national and local, are ready to sell PMDs to anyone interested. And hey, if you’re after a bargain, some retailers offer used or spruced-up models for a fraction of the original price. 

Buying used might mean taking it as is, or maybe with a limited warranty. You can also look for used PMD models in your local newspaper or similar online ads.