Medicare Advantage denied a power wheelchair or scooter? What the rule says and how to appeal.
Checked against the current rules on September 18, 2026.
A denial for a power wheelchair or scooter isn't the end of the story — Medicare Advantage plans have to follow specific coverage rules, and a denial that doesn't square with those rules is exactly the kind of appeal that tends to win.
Here's what the rule actually requires, what evidence usually turns a denial around, and the deadline you're working against.
What the rule requires
Coverage for a power wheelchair or scooter under a Medicare Advantage plan is governed byPower Mobility Devices. A Medicare Advantage plan generally cannot apply a stricter test than what these rules require.
Questions that decide it
Before you appeal, these are the facts that usually decide whether a denial like this holds up:
Does the mobility limitation keep the patient from daily activities inside the home (bathing, dressing, getting to the bathroom)?
Has a cane, walker, or manual wheelchair already been tried and found not to work well enough?
Did a doctor do an in-person mobility exam and write an order for this specific device?
What a winning appeal has to show
An appeal that wins usually includes:
Documentation of the mobility limitation's effect on activities of daily living (toileting, bathing, dressing, etc.) — The LCD requires the limitation significantly impair one or more mobility-related ADLs in the home. (Your doctor's office provides this.)LCD L33789
Notes on the cane/walker/manual-wheelchair trial and why it wasn't sufficient — Coverage requires the limitation not be sufficiently resolved by a lesser device. (Your doctor's office provides this.)LCD L33789
The physician's Standard Written Order (SWO) for the specific device — A PMD base requires an SWO prior to delivery. (Your doctor's office provides this.)LCD L33789
Notes from the required in-person mobility examination — Establishes the exam and order actually occurred, as the LCD requires. (Your doctor's office provides this.)LCD L33789
Your deadline to appeal
65 days from the date on the notice. The rule (42 CFR § 422.582) gives you 60 days from when you receive the denial, and receipt is presumed to be 5 days after the notice's own date unless shown otherwise — 60 + 5 = 65 days from the notice date.42 CFR 422.582
The plan itself then has its own clock to decide. The plan must decide within 30 calendar days for a request about a service you haven't received yet, 60 calendar days for a request about payment for something already provided, or 72 hours if the request is expedited (42 CFR § 422.590).
What to ask your doctor to address
If you're asking the treating physician for a supporting letter, it should speak to:
Which specific activities of daily living are impaired and how (unable to complete, unsafe, or unreasonably slow).LCD L33789
Why a cane, walker, or manual wheelchair does not sufficiently and safely resolve the limitation.LCD L33789
The date of the in-person mobility examination and the specific device ordered.LCD L33789
Questions people ask
- Can the plan just say it's "not medically necessary" with no further explanation?
- The denial notice has to explain the basis for the decision and tell you how to appeal. If it doesn't point to a specific rule or criteria, that's itself worth raising in your appeal — you're entitled to know what standard was applied.
- What if I don't have all the evidence listed above?
- Include what you have. An appeal with partial evidence and a clear explanation of the rule still gets a real review — it doesn't need to be complete to be worth filing.
Sources — last checked September 18, 2026
- 42 CFR 422.582as of September 18, 2026
- Power Mobility Devicesas of October 1, 2025
Related
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By CaseWhy Appeals editorial. See how this content is produced. Not legal advice. Not affiliated with or endorsed by Medicare, CMS, or any health plan. A product of CaseWhy LLC.
