CG-DME-31 Powered Wheeled Mobility Devices

This policy addresses powered wheeled mobility devices, including powered/motorized wheelchairs (with or without power seating), pushrim-activated power assist devices (PAPAWs), and power-operated vehicles/scooters. Coverage is medically necessary only when both general criteria and one device-specific criterion are met: a clinician’s written assessment documents inability to perform MRADLs, the home environment supports use, the individual can safely and consistently operate the device in a trial, and lower-level aids are insufficient. Not covered when used solely outdoors or only for community mobility if the person can ambulate at home, when the device exceeds the individual’s basic needs, or as a backup device.

"Powered/motorized wheelchairs, with or without power seating systems, pushrim activated power assist device (an addition to a manual wheelchair to convert to a PAPAW) or power operated vehicles (PO..."