POV-Scooter

Power Mobility – Scooter / POV

A mobility scooter has a seat over two rear wheels a flat area for the feet and handlebars in front to turn one or two steerable wheels. The seat may swivel to allow access when the front is blocked by the handlebars. Mobility scooters are usually battery powered.

The tiller, with forward/reverse directions and speed controls, is the steering column centrally located at the front of the scooter. Forward/reverse direction can be controlled by thumb paddles, finger controls, or a switch. There are two types of mobility scooters: front-wheel drive (FD) or rear-wheel drive (RD). The FD is usually a smaller device and is best used indoors. Rider weight capacity is generally upwards to 250 pounds maximum. The RD is used both indoors and outdoors with rider weight capacity of 350 pounds. A heavy duty RD is capable of carrying up to 500 pounds, varying by manufacturer.

HCPCS Code:

K0800 – K0802

Category:

Purchase, or Capped Rental – patient choice

Common Diagnosis:

Any diagnosis that impairs the patient’s ability to ambulate within the home

Coverage Information

Requires a Detailed Written Order (7 point order) obtained prior to delivery, and within 45 days of the required PMD related physician face to face evaluation.

Covered if the following criteria are met:

A) The patient has a mobility limitation that prevents the patient from accomplishing an MRADL entirely, or places the patient at risk of injury when perform an MRADL; or prevents the patient from completing an MRADL within a reasonable time frame, AND

B) The mobility limitation cannot be resolved with and cane or walker, AND

C) The patient has insufficient upper body strength to propel in a manual wheelchair (objective measurements of range of motion and upper body strength testing are ideal), AND

D) The patient is able to safely transfer to and from the POV, and operate it, AND

E) The patient has the mental acuity necessary to operate the POV, AND

F) The patient’s home is accessible with the POV (supplier must complete home evaluation), AND

G) The patient’s weight is less than or equal to the capacity of the POV, AND

H) The POV will improve the patient’s ability to perform MRADL, AND

I) The patient has not expressed an unwillingness to use a POV

Note 1: The patient must receive a face to face evaluation by the ordering physician, AND the physician’s notes must reflect that the above coverage criteria are met.

Note 2: The physician’s notes from the face to face evaluation are THE most important determinate of being reimbursed! A supplier provider form filled out by the physician as documentation of the face to face evaluation is not sufficient to withstand an audit (either pre- or post-payment)! From the Medicare LCD: “Physicians shall document the examination 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 examination. Many suppliers have created forms which have not been approved by CMS which they send to physicians and ask them to complete. Even if the physician completes this type of form and puts it in his/her chart, this supplier-generated form is not a substitute for the comprehensive medical record as noted above.”

Note 3: The insufficiency of upper body strength is the main qualifier that separates qualification for a power mobility device (PMD) versus a manual wheelchair. Physician notes should clearly discuss the reason for the upper body strength insufficiency such as: actual upper body physical limitations that have been objectively measured; inadequate range of motion that has been objectively measured; upper body pain that has been well documented over a period of time (chronic); the absence of one or both extremities due to amputation, and/or upper and lower body endurance / stamina.

Note 4: Encourage the physician to document the following types of information in the face to face evaluation notes:


Symptoms
Related diagnoses
History:
 How long the condition has been present
 Clinical progression
 Interventions that have been tried and the results
 Past use of walker, manual wheelchair, POV, or power wheelchair and the results
Physical exam:
 Weight
 Impairment of strength, range of motion, sensation, or coordination of arms and legs
 Presence of abnormal tone or deformity of arms, legs, or trunk
 Neck, trunk, and pelvic posture and flexibility
 Sitting and standing balance

Functional assessment -- description of any problems with performing the following activities including the need to use a cane, walker, or the assistance of another person:

 Transferring between a bed, chair, and POV
 Walking around their home – to bathroom, kitchen, living room, etc. – provide information on distance the patient is able to walk without stopping, speed and balance


Document/affirm the patient's physical and mental abilities to transfer into the POV and to operate it safely within the home

Provide an explanation of why less costly mobility aides are not sufficient to resolve the patient's mobility deficit

Note 5: The face to face evaluation should contain objective, rather than subjective statements. Remind physicians that the information regarding the patient’s mobility limitations should be objective or measurable. Subjective statements are open to individual interpretation and do not offer a clear picture of the beneficiary’s mobility status. Objective information, on the other hand, provides a common quantifiable reference.

FOR EXAMPLE:

Subjective Information - No | The patient has difficulty walking and can only walk short distances. | The patient needs power mobility in order to complete MRADLs. He is too unstable to use a cane or walker and does not have the endurance to propel a manual wheelchair. | The patient has weakness in the upper extremities.

Objective Information - Yes | The patient becomes short of breath after walking 15-20 feet and must stop and rest. | The patient does not have the stability to walk from the bedroom to other rooms in the house with either a cane or walker. He has experienced two falls in the past month in his home despite use of a wheeled walker. A trial with a lightweight manual wheelchair failed. Severe osteoarthritis in shoulders and wrists has resulted in limited range of motion and propelling the wheelchair more than 15 feet results in pain rated at 7/10. | Strength in right upper extremity is 3/5 and 2/5 on the left. Patient cannot lift more than 5 pounds.

Note 6: You must provide the least costly alternative that the patient qualifies for – POV versus Power wheelchair. Determinations of least costly alternative must take into account the patient’s weight, seating needs, and needs for other special features (i.e., power seating systems, alternative drive controls, and / or ventilators). If the patient can safely transfer to and from a POV, and operate the tiller steering system, and maintain postural stability and position while operating the POV in the home, and no other special features are needed, a POV should be provided instead of a more costly power wheelchair.

Note 7: Use KX modifier to denote that all required documentation is on file.

Documentation Requirements: in addition to the basic Medicare documentation (proof of delivery, AOB, etc.)

1. 7 Point Detailed Written Order: The physician’s order must be received by the supplier within 45 days of the face to face evaluation (it must be date stamped by the supplier upon receipt from the physician in order to document that it was received within 45 days of the face to face evaluation). The order must contain the following 7 items and be on the physician's own form:
 Beneficiary’s name
 Description of the item that is ordered. This may be general – e.g., “power operated vehicle”, “power wheelchair”, or “power mobility device”– or may be more specific
 Date of the face-to-face examination
 Pertinent diagnoses/conditions that relate to the need for the POV or power wheelchair
 Length of need
 Physician’s signature
 Date of physician signature

2. Detailed Product Description: Once the supplier has determined the specific power mobility device 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 wheelchair base and all options and accessories that will be separately billed. For the wheelchair base and each option/accessory, the supplier must enter all of the following:
 HCPCS code
 Narrative description of the item
 Manufacturer name and model name/number
 Supplier’s charge
 Medicare fee schedule allowance

If there is no fee schedule allowance, the supplier must enter “not applicable”. The physician must sign and date this detailed product description and the supplier must receive it prior to delivery of the PWC or POV. A date stamp or equivalent must be used to document receipt date. The detailed product description must be available on request.

3. Face to Face Evaluation: As detailed above. The evaluation must clearly indicate that a major reason for the visit was a mobility examination.

4. Home Mobility Evaluation Assessment: Completed by the supplier, and documents that the home environment is accessible to the PMD provided. Medicare coverage only pertains to equipment needed within the home, therefore you are not required to assess access to entry from outside the home, or any area outside the home environment.

5. Optional - PT/OT Evaluation: Some suppliers find it helpful to require the physician referral source to order a PT/OT evaluation before accepting the patient. The PT or OT evaluation is completed prior to the physician face to face evaluation. The ordering physician is then able to refer to the testing and evaluation performed by the PT or OT when completing their own documentation. This may assist the physician in documenting a more objective (and not subjective) mobility evaluation.

If a PT/OT evaluation is performed the supplier must obtain a signed, dated attestation from the PT/OT that affirms that the supplier has no financial relationship with the PT/OT.