CG-DME-24 Wheeled Mobility Devices: Manual Wheelchairs - Standard, Heavy Duty and Lightweight

This policy addresses standard, lightweight, and heavy-duty manual wheelchairs. Coverage is medically necessary with a written clinician assessment showing the member lacks functional mobility to safely/efficiently perform in-home ADLs, the home environment supports wheelchair use, and the member can safely operate it or has a trained caregiver to do so. Not covered when intended solely for outdoor use, when the device exceeds basic needs, when used as a backup if the primary device needs repair, or for leisure/recreational purposes.

"A standard, heavy duty or lightweight manual wheelchair is consideredmedically necessarywhenallof the following are met:"

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