Navigating the Medicare mobility assistive equipment algorithm involves several critical clinical and administrative steps to determine eligibility for a Custom Motorized Wheelchair. We are here to help you through this structured process to ensure all requirements are met for your greater independence.

1. Face-to-Face Mobility Evaluation: You must participate in an in-person clinical assessment with your treating healthcare professional. This evaluation documents your functional limitations and how they interfere with daily activities at home.
2. Daily Mobility and Functional Assessment: During the evaluation, your clinician will verify if your mobility limitations cannot be resolved by a cane, walker, or manual wheelchair. This includes assessing your ability to safely operate a power wheelchair.
3. Documented Walker Trial: Part of the algorithm involves recording that a trial of a lower-level device, such as a walker, was insufficient to meet your daily needs safely.
4. Preparation of Clinical Documentation: Your physician must provide a written prescription and detailed medical records from the evaluation. This may also include a Certificate of Medical Necessity supporting the need for a motorized device.
5. Prior Authorization Request: We submit the formal request (Form CMS-10211) to Medicare on your behalf, including all clinical notes and evaluation results. Medicare requires this prior authorization before the equipment can be dispensed.
6. Personalized Fitting: Once approved, we conduct a personalized fitting in our Spring Valley, NY clinic to tailor the chair’s ergonomics and controls to your specific needs.

Note: Results may vary. Verify Medicare/insurance coverage; we do not guarantee coverage. Please consult your treating healthcare professional regarding medical necessity.

• Medicare Mobility Assistive Equipment Algorithm Explained