Medicare Power Mobility Documentation Requirements

In order to process a patient’s Medicare claim for power mobility, equipment suppliers must have the following documentation on file prior to the equipment delivery:

Physician Face-to-Face Visit with Patient & Chart/Progress Notes (conducted by the physician with copies to the equipment supplier):

The chart notes must indicate there was a face-to-face meeting between the patient and physician for the purpose of a mobility evaluation. The face-to-face meeting may take place prior to or after a PT/OT Assessment. A detailed summary should include the patient diagnostic history, strength assessment, range of motion, previous mobility assistive equipment use, and why existing assistive equipment is no longer suitable or safe for use (i.e., cane, walker, optimally-configured manual wheelchair). The medical record should indicate that the patient has one or more mobility-related limitations within the home and that the mobility equipment ordered will alleviate these limitations.

PT/OT Assessment (ordered by the physician and conducted, signed, and dated by the PT/OT and co-signed by the physician):

The evaluation must be sent to the physician for a signed/dated statement of concurrence (or disagreement) after completion. If the physician disagrees with any portion of the assessment, it must be documented prior to signing.

 7 Element Order (completed, signed, and dated by the physician and including the following:

  • Patient name,
  • Item for order,
  • Date of the face-to-face exam (same as the date the physician signs the PT/OT eval)
  • Diagnoses and diagnoses codes
  • Length of need
  • Physician signature
  • Date of signature

The order must be written after the physician completes the face-to-face assessment/physical exam or, if a PT/OT clinical assessment is ordered, after the physician signs the PT/OT evaluation. Equipment suppliers are not allowed to complete the 7 Element Order for the physician’s signature.

Detailed Product Description (completed by the equipment supplier and signed and dated by the physician ordering the equipment):

This form must be completed by the equipment supplier and contains all items billable to Medicare, including the HCPC, Description of item (manufacturer, model, retail charge, and Medicare allowable). It must be signed and dated by the physician.

In-Home Assessment (completed, signed, and dated by the equipment supplier):

The in-home assessment must be completed by the equipment supplier and must demonstrate that the power mobility equipment can be adequately maneuvered inside the home considering the physical layout, doorway widths, thresholds and surfaces.

Attestation (completed, signed, and dated by the equipment supplier):

This document attests that there is no financial arrangement between the PT or OT and the supplier.