Source: U.S. Rehab / Dan Fedor, VGM — February 15, 2023
What Changed (Effective January 1, 2023)
Prior to Jan. 1, 2023:
- Continued need had to be documented in the medical record (chart note, etc.)
- An order alone was not sufficient
- Required within 12 months preceding the date of repair
- In practice: patients often needed a dedicated office visit just to confirm continued need
- This delayed repairs, as continued need had to be in hand before the wheelchair could be returned
Effective Jan. 1, 2023:
- An order is now acceptable to establish continued need for wheelchair repairs
- Most practitioners will write this order without requiring an office visit
- Since an order is valid for 12 months, one order per 12 months satisfies continued need
When Medicare Paid for the Wheelchair
- Medical necessity (MN) is already established — no additional MN documentation required
- Only needed: order for wheelchair repairs + tech work ticket
- Applies regardless of which supplier Medicare paid
- If the original supplier won’t repair the chair, the patient may go to a different supplier — the same simplified requirements apply
When Medicare Did NOT Pay for the Wheelchair
Both of the following are required:
- Order for continued need (same as above), AND
- Documentation justifying medical necessity for the wheelchair, since MN has not been established through Medicare
Acceptable MN Documentation
- Original documentation from when the patient received the wheelchair, provided it:
- Rules out least costly alternatives
- Includes objective measurements for the wheelchair base
- Justifies the accessories
Warning
If Medicare didn’t pay for the chair, the repair claim may be subject to an Additional Documentation Request (ADR) asking for proof of medical necessity for the item being repaired.
Quick Reference
| Scenario | Required Documentation |
|---|---|
| Medicare paid for the wheelchair | Order for repairs + tech work ticket |
| Medicare did NOT pay for the wheelchair | Order for repairs + original MN documentation |
Tags
billing wheelchair-repair continued-need medical-necessity ADR medicare documentation