Power wheelchairs and scooters: the coverage test

A denial that says the patient "can walk" or "doesn't need" a power device often hasn't actually addressed the real test — whether a LESSER device (a cane, walker, or manual wheelchair) would sufficiently and SAFELY resolve the specific mobility limitation, not whether the patient can move at all.

The in-person mobility exam is a hard requirement, not a formality — a device ordered without one, or based only on a phone or telehealth visit, generally doesn't meet the standard, and a denial citing a missing in-person exam is worth checking against the actual visit records.

Documentation should be specific about WHICH activities of daily living are affected and HOW (unable to do it, unsafe to attempt it, or unreasonably slow) — a general statement that mobility is "limited" doesn't meet the rule's own specificity requirement.

The specific device ordered (a scooter vs. a power wheelchair, with or without specific seating or positioning features) has to match what the exam and the documented limitation actually support — a denial for "insufficient documentation" often means the paperwork didn't connect the specific device features to the specific functional need, not that no need exists at all.

Home assessments — confirming the device can actually be used inside the patient's own home (doorways, turning space, ramps) — are sometimes requested separately and can add real delay; asking early whether one is needed avoids a late-stage surprise that pushes out the whole timeline.

Because this is a Local Coverage Determination rather than a national one, the exact documentation checklist can vary slightly by region — CaseWhy Appeals' own evidence checklist for this contested item reflects the specific LCD's real requirements, not a generic national assumption.