CG-DME-34 Wheeled Mobility Devices: Wheelchair Accessories

This policy addresses coverage of options and accessories for wheeled mobility devices, including manual wheelchairs, power/motorized wheelchairs (with or without power seating), and power-operated vehicles (POVs). Accessories are covered when they are medically necessary and all device, general, and specific criteria are met; they are not covered when intended mainly for outdoor use, exceed what is medically necessary, are backups or for anticipated future needs, or enable leisure/recreational activities (e.g., auto carriers, bags/baskets, cup/phone/crutch holders, firearm holders, ice-chest frames, stair or car-trunk lifts, manual seat-lift mechanisms, automobile racks, and non-attached vest-type trunk supports). Key limitations: all three criteria sets (A, B, and C) must be satisfied, and comfort, luxury, or convenience items are excluded.

"Options or accessories are consideredmedically necessarywhenALLof the followingdevice,general,andspecificcriteria below (AandBandC) are met:"