Motorized Wheelchair K0821

Product Details

• 20" high Luxurious Leatherette
• 20" high back recline executive seat
• Stable 4 post seating system
• Adjustable length, height and flip-up foot plate
• Adjustable width, height and flip-up arm rest
• Mid-wheel drive maneuverability
• 10" wheel
• 300 pound capacity back recline executive seat
 

RELATED ITEMS:

• Elevated Leg Rest
• Back Cushion (If prone to ulcers)
• Seat Cushion (If prone to ulcers)
• Hospital Bed (Semi-Electric)

PAPERWORK NEEDED:

• Prescription (Rx)
• Face-To-Face Evaluation
• Doctor's Progress Notes
• Title XIX and Physical Therapy Evaluation

(If The Primary Insurance Is Medicaid)

HCPCS CODE: K0821

INSURANCE REIMBURSEMENT:

• Purchase:
$3,307.70 Onetime Payment

QUALIFYING CRITERIA:

The Prescription (Rx) must be received by the wheelchair supplier within 45 days after completion of the physician's face-to-face examination, and prior to delivery of the power chair.

The report of the face-to-face examination shall provide information relating to the following questions:

• What is this patient's mobility limitation and how does it interfere with the performance of activities of daily living?
• Why can't a cane or walker meet this patient's mobility needs in the home?
• Why can't a manual wheelchair meet this patient's mobility needs in the home?
• If a power wheelchair is provided, why can't an electric mobility scooter meet this patient's mobility needs in the home?
• Does this patient have the physical and mental abilities to operate a power wheelchair safely in the home?
• Is the patient willing and motivated to use a power wheelchair?