Power Wheelchairs and Accessories - DME.WC.107.A

Power wheelchairs (Groups 1–5), medically necessary accessories and custom power bases are covered for home use when required to perform MRADLs and less restrictive devices/manual wheelchairs/POVs are inadequate or unsafe, while excluded items include PWCs for outdoor‑only use, standing features/standing wheelchairs, powered seat cushions, stair‑climbing chairs, robotic arms, non‑sealed batteries, leisure accessories, commode seats, multiple/backup or same‑or‑similar replacement wheelchairs. Coverage requires treating‑practitioner clinical documentation (and a trained wheelchair evaluator for Group 2 power options, Groups 3–5 with power options, pediatric PWCs, power seat elevation, etc.), adherence to HCPCS group/weight/battery limits (max two batteries, one lithium battery typically every 3 years), and demonstration of specific medical indications for requested options/accessories.

"Documentation supporting need for positioning devices (weak trunk muscles, seating asymmetry, increased muscle tone)."