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MANUAL 
wheelchairs

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Standard Wheelchair
(Provided when going through Insurance)
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OUR MOST POPULAR SELLING WHEELCHAIR!
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MANUAL WHEELCHAIR ORDER PROCESS

STEP 1 - SCHEDULE A FACE-TO-FACE OFFICE VISIT WITH THE ORDERING PHYSICIAN- REFERENCE GUIDE
STEP 2 - ORDERING PHYSICIAN COMPLETES THE STANDARD WRITTEN ORDER (SWO)

STEP 3 - FAX SWO AND CHART NOTES FROM PATIENT'S FACE-TO-FACE MOBILITY EXAM TO 704-821-7777 

(email orders to orders@ncdme.com)



ONCE WE RECEIVE THE DOCUMENTATION ABOVE WE WILL SUBMIT TO MEDICARE/INSURANCE COMPANY
FOR PRIOR AUTHORIZATION.  
WE NORMALLY HEAR BACK FROM MEDICARE/INSURANCE COMPANY WITHIN 10-14 BUSINESS DAYS WITH A DECISION. 

WANT TO GO THROUGH INSURANCE?
COMPLETE FORM AT BOTTOM OF THIS PAGE

Information for Prescribing Manual Wheelchairs - Determining your Patients' Mobility Needs

Once you've determined from the face-to-face mobility evaluation that your patient's mobility needs would best be served with a manual wheelchair, you'll need to provide the following documentation within 45 days of your face-to-face mobility evaluation:

  • Prescription/7 Element Written Order for a manual wheelchair

  • Chart notes that detail the patient's mobility need and a written summary of the face-to-face evaluation

  • Once the supplier has determined the specific wheelchair that is appropriate for the patient based on the physician's order, the supplier must prepare a written document (termed a detailed product description) that lists the specific base (HCPCS code and either a narrative description of the item or the manufacturer name/model) and all options and accessories that will be separately billed. The physician must sign and date this detailed product description and the supplier must receive it prior to delivery of the wheelchair.
     

The face-to-face examination report must address the following:

  • Patient's mobility limitation and how it interferes with the performance of activities of daily living

  • Why can't a cane or walker meet this patient's mobility needs in the home?

  • How will a manual wheelchair meet this patient's mobility needs in the home?

  • Is the patient willing and capable of safely operating the manual wheelchair in their home?

  • The Standard Written Order (SWO) must include:

  • Order Date

  • Beneficiary's (patient's) first and last name

  • Beneficiary's Date of Birth

  • Detailed description of the item that is ordered

  • Date of the face-to-face examination

  • Pertinent diagnosis/conditions that relate to the need for a wheelchair

  • Length of time the patient will need the device

  • Quantity of item being ordered

  • Physician's signature

  • Date of physician's signature



The report shall provide pertinent information about the following elements, but may include other details.1

  • Symptoms & related diagnoses

  • How long the condition has been present

  • History & clinical progression

  • Interventions (including medications) that have been tried and the results

  • Past use of a cane, walker, or other mobility aid and the results

  • Physical exam & weight

  • Impairment of strength, range of motion, sensation or coordination of arms and legs

  • Presence of abnormal tone, deformity of arms, legs or trunk

  • Neck, trunk, and pelvic posture and flexibility

  • Sitting and standing balance

  • Functional assessment - problems performing the following activities including the need to use a cane, walker or aid of another person:

    • Transferring between a bed or chair and power mobility product

    • Walking to & from the bathroom, kitchen, living room, etc.

    • Distance patient is able to walk without stopping; speed, and balance

The elements that are addressed will depend on the diagnoses that are responsible for the mobility deficit. For example, for patients with COPD, heart failure or arthritis, the major emphasis will be on symptoms and history of the progression of their condition rather than on the physical examination.

Functional Assessment
Physicians shall also provide reports of pertinent laboratory tests, x-rays, and/or other diagnostic tests (e.g., pulmonary function tests, cardiac stress test, electromyogram, etc.) performed in the course of management of the patient. Although patients who qualify for coverage of a power chair may use that device outside the home, because Medicare's coverage of a wheelchair is determined solely by the patient's mobility needs within the home, the examination must clearly distinguish the patient's abilities and needs within the home from any additional needs for use outside the home. Physicians shall document the evaluation in a detailed narrative note in their charts in the format that they use for other entries. The note must clearly indicate that a major reason for the visit was a mobility evaluation.

 


***Physicians will be provided an additional payment, using code G0454, for signing/co-signing the face-to-face encounter of the PA/NP/CNS. The physician should not bill the G code when he/she conducts the face-to-face encounter. Note that the G code may only be paid to the physician one time per beneficiary per encounter, regardless of the number of covered items documented in the face-to-face encounter.

 

If trying to go through insurance please submit the information on the form below and someone will get in touch soon.

Patient Information

Mobility & More Corporate Location

251 N Trade St.

Matthews, NC 28105

Open Mon-Fri from 10AM-5PM

704-821-7777 ext 101

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