Options and accessories for wheelchairs are covered if the patient has a wheelchair that meets Medicare coverage criteria and documentation in the patient’s medical
record substantiates the medical necessity for the item.
The coverage criteria for the most commonly ordered accessories are:
- Adjustable arm height option – The patient requires an arm height that is different than
that available using non-adjustable arms and the patient spends at least 2 hours per
day in the wheelchair.
- Arm trough- The patient has quadriplegia, hemiplegia, or uncontrolled arm movements.
- Elevating legrests – The patient has a musculoskeletal condition or the presence of a
cast or brace which prevents 90 degree flexion at the knee, or the patient has significant edema of the lower extremities that requires an elevating largest, or the patient meets the criteria for and has a reclining back on the wheelchair.
- Non-standard seat width an/or depth – The patient’s physical dimensions justify the
- Anti-rollback device- The patient self-propels and needs the device because of ramps.
- Safety belt/pelvic strap – The patient has weak upper body muscles, upper body insta-bility or muscle spasticity which requires use of this item for proper positioning.
- Manual fully reclining back – The patient has one or more of the following conditions
documented in the medical record:
• At high risk for development of a pressure ulcer and is unable to perform a
functional weight shift;
• The patient utilizes intermittent catheterization for bladder management and is
unable to independently transfer from the wheelchair to the bed.