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Both manual and electric wheelchairs can be customized with a variety of options and accessories. These "extra" features make your chair individualized for your particular needs and also can add conveniences that wheelchair users appreciate.
Options for Physical or Medical Needs
Many times a person's particular disability or health issue will necessitate custom-fitted additions or adaptions to their wheelchair. The doctor or occupational therapist that conducted your evaluation will make these kinds of recommendations. You will then know exactly how your wheelchair should be modified to best suit you. Safe use of your chair is also an important issue.
- Fit and function: These options or accessories customize the fit and function of your chair. If you are very tall or obese, your wheelchair will need to be adjusted for that. For instance, if you are unable to use the armrests on your chair because of a poor fit for longer arms, you will need customized parts.
- Medical necessity: If you are an amputee, you will need specially-adapted features on your wheelchair. You might need an option that offers additional support for a part of your body, because of a particular disability. If you spend almost all of your time in your wheelchair, your seat cushion is a very critical option.
Options and Accessories for Convenience or Lifestyle Fit
Because people in wheelchairs spend so much time using them, it's important that they have accessories and options that will make "living" in the chair much more convenient. Carrying items, transporting your wheelchair in vehicles, safety add-ons, like mirrors and lights can all make your chair easier to handle and accommodate your lifestyle.
Some of these accessories or options include:
- Baskets, bags, for the front and back of your wheelchair
- Fabric choices for your seat cushions
- Cup holders and other brackets or holders
- Lifts or racks to transport the chair on a vehicle
- Additional battery chargers
- Upgraded tires
Your wheelchair supplier can show you options that can be used with your particular chair. You may want to go to a showroom to try them out before deciding which to purchase.
Does Medicare Cover Wheelchair Options and Accessories?
This is an area of your Medicare benefit that has recently been revised. It's very important that you understand the options and accessories that are considered appropriate for Medicare reimbursement. In order for any wheelchair accessory or option to be covered by Medicare, it must be:
- Medically necessary: There are very strict criteria for this category. An order or prescription from your doctor is required to be submitted to Medicare. There must be adequate documentation that provides the reasons why a particular wheelchair accessory is a medical necessity.
- Medicare will not pay for equipment ordered without the proper documentation.
Guidelines Revised February, 2011
The following is the language regarding Medicare coverage of wheelchair accessories and options. These were revised on February 4, 2011:
- Non-medically Necessity Coverage and Payment: "For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements."
Your doctor and/or occupational therapist will know how to request coverage of some items that they feel are medically necessary. You will need to work with them to determine the exact rules about these wheelchair options and accessories.
Changes to Medicare Coverage for Durable Medical Equipment for 2011
If the wheelchair accessories and options are covered by Medicare Part B, the following new guidelines apply:
As of January, 2011, there are new guidelines for Durable Medical Equipment. Medicare is using a new program called "competitive bidding" to help save you and Medicare money and ensure that you get quality equipment, supplies, and services. In some areas of the country, you must use specific suppliers or Medicare will not pay for the item. It's important to see if you are affected by this new program. It is now effective in the following states: CA, FL, IN, KS, KY, MO, NC, OH, PA, SC, TX.
If the options or accessories you need are covered by Medicare, most of the cost will be covered by Original Medicare Part B. You will be responsible for 20% and will need to meet your Part B deductible.
Wheelchair Options and Accessories NOT Covered by Medicare
Most of the items listed under the category of convenience or lifestyle will not be covered by Medicare because they are not considered medically necessary. This would include things that are for use outside the home and/or to do outdoor activities.
Examples of those options and accessories are:
- Holders for cups, canes, or crutches
- Bags or pouches in which to carry items while in your chair
- Anything used to transport your wheelchair with a vehicle
- Wheelchair ramps
Advocacy
Because of the strict payment guidelines for options and accessories for your wheelchair, you may have to ask your health care provider to advocate for your needs. If they can make a compelling case that an item that you require is medically necessary, you may be able to have that item covered.
The "convenience" items will not be covered by Medicare as they are not considered to be of medical necessity.
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