Medicare Coverage Workspace

DME Claim Record / ·

Authority Source

CMS Medicare LCD: Power Mobility Devices

LCD L33789 (2025) · 22pp

SOC 2 Type II · ISO 27001

Medicare LCD: Power Mobility Devices

What the policy requires for coverage. Use this as a reference when reviewing denials or preparing submissions.

BILLING PATHWAY Determine how this claim should be billed before checking coverage criteria.

SNF consolidated billing rules affect who bills Medicare.

Billing Pathway

2 ▾

Determine how this DMEPOS claim should be billed based on patient location and Part A status.

If the beneficiary is currently in a covered Part A SNF stay, most DMEPOS items are included in the SNF's consolidated billing payment (42 CFR 411.15(p)). The DME supplier bills the SNF, not Medicare. If Part A is exhausted or does not apply, the supplier bills Medicare Part B directly. 42 CFR 411.15(p)
Certain DMEPOS items are excluded from SNF consolidated billing and may be billed directly to Medicare Part B even during a covered Part A stay. These include customized prosthetic devices, certain orthotics, and items specifically excluded by regulation. 42 CFR 411.15(p)(2)

COVERAGE ELIGIBILITY All criteria must be met for Medicare coverage of the power mobility device.

Each requirement is a gate. If any fails, the claim will be denied.

Mobility Limitation

2 ▾

The beneficiary must have a mobility limitation in the home.

Per LCD coverage criteria (L33789), the beneficiary has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADLs): toileting, feeding, dressing, grooming, and bathing. The F2F must demonstrate the mobility limitation in the home specifically. p. 4
16% of PMD non-affirmations: F2F doesn't demonstrate mobility limitation in home.
The mobility limitation cannot be sufficiently and safely resolved by the use of an appropriately fitted cane or walker. The F2F must document why a cane or walker is insufficient, not just that the beneficiary prefers a PMD. p. 4
30.3% of PMD non-affirmations: F2F doesn't demonstrate cane/walker is insufficient.

Device Justification

5 ▾

The specific device type must be justified based on clinical need.

Scooter vs power wheelchair determination: if a scooter (POV) is requested, the beneficiary must have sufficient upper extremity function to operate the tiller steering. If a power wheelchair is requested, the documentation must establish why a scooter is not appropriate. pp. 5-6
72% of PMD non-affirmations involve the scooter vs wheelchair determination.
If a power wheelchair is requested, the beneficiary does not have sufficient upper extremity function to self-propel an optimally-configured manual wheelchair in the home to perform MRADLs during a typical day. p. 5
The F2F examination must document the beneficiary's upper extremity function sufficient to operate the requested PMD. For power wheelchairs: ability to operate a joystick or alternative drive control. For scooters: ability to operate tiller steering and hand controls. pp. 5-6
35% of PMD non-affirmations: F2F doesn't demonstrate upper extremity function.
The beneficiary must be able to safely operate the power mobility device, or have a caregiver who is able and willing to operate the device on their behalf. pp. 6-7
The beneficiary's home must provide adequate access for the device (doorway widths, turning radius, floor surfaces). p. 7

Failed Less Costly Alternatives

2 ▾

Documentation that less costly mobility options were considered and are insufficient.

A cane or walker has been considered and ruled out because the beneficiary is unable to use them safely and effectively due to the nature of the mobility limitation. p. 4
If a power wheelchair is requested, a manual wheelchair has been considered and ruled out because the beneficiary does not have sufficient upper extremity function to self-propel. p. 5
Required only for power wheelchair requests, not scooters.

POV-Specific Criteria

3 ▾

Additional coverage criteria for Power Operated Vehicles (scooters). Criteria D-I per LCD L33789.

The beneficiary is able to safely transfer to and from the POV, operate the tiller steering system, and maintain postural stability and position while operating the POV in the home. p. 2 (Criterion D)
Noridian JD: 6% non-affirmation rate for safe transfer; 5% for tiller steering. POV only.
The beneficiary's mental capabilities (cognition, judgment) and physical capabilities (vision) are sufficient for safe mobility using a POV in the home. p. 2 (Criterion E)
POV only.
The beneficiary has not expressed an unwillingness to use a POV in the home. p. 2 (Criterion I)
POV only. Beneficiary willingness is a coverage requirement.

PWC-Specific Criteria

4 ▾

Additional coverage criteria for Power Wheelchairs. Criteria J-O per LCD L33789.

The beneficiary does not meet coverage criterion D, E, or F for a POV (cannot safely transfer, operate tiller, or home does not accommodate a POV). p. 3 (Criterion b)
PWC only. Must document why a POV is not appropriate.
The beneficiary has the mental and physical capabilities to safely operate the power wheelchair; or if unable, a caregiver is available, willing, and able to safely operate it. p. 3 (Criteria J/K)
PWC only.
Use of a power wheelchair will significantly improve the beneficiary's ability to participate in MRADLs and the beneficiary will use it in the home. p. 3 (Criterion N)
PWC only.
The beneficiary has not expressed an unwillingness to use a power wheelchair in the home. p. 3 (Criterion O)
PWC only. Beneficiary willingness is a coverage requirement.

DOCUMENTATION REQUIREMENTS Required documents that must be present in the medical record. ▾

Missing documentation is the #1 reason for DMEPOS claim denials.

Face-to-Face Examination

3 ▾

A qualifying face-to-face exam must be performed and documented.

The treating practitioner who completes the face-to-face requirements must be the same practitioner who writes the order/prescription for the PMD (base item). p. 19
The face-to-face encounter must be conducted within six (6) months prior to the order date on the WOPD for the PMD (base item). p. 19
The report of the face-to-face encounter should provide information relating to the beneficiary's mobility limitation, history of the present condition, and physical exam findings. pp. 19-20

Specialty Evaluation

2 ▾

A specialty evaluation for certain PWC types and power assist systems.

The specialty evaluation that is required for beneficiary's who receive a Group 2 Single Power Option or Multiple Power Options PWC, any Group 3 PWC, or a power assist system is in addition to the requirement for the face-to-face encounter. p. 22
The specialty evaluation provides detailed information explaining why each specific option or accessory (power seating system, alternate drive control interface, or power assist system) is needed to address the beneficiary's mobility limitation. There must be a written report of this evaluation available on request. p. 22

Home Assessment

2 ▾

On-site home assessment documenting device accessibility.

An on-site evaluation of the beneficiary's home must document adequate access between rooms, maneuvering space, and surfaces for the operation of the power mobility device. pp. 2-3 (Criteria F/M); Noridian checklist
The home assessment report must document specific measurements: doorway widths, hallway widths, turning radius at key locations, floor surface types, and any accessibility barriers or modifications. Noridian checklist; LCD L33789 implied

LCMP Concurrence

1 ▾

Physician concurrence when LCMP examination is part of the F2F.

If the report of a licensed/certified medical professional (LCMP) examination is to be considered as part of the F2F, there must be physician concurrence or disagreement with the LCMP examination. p. 19; Noridian checklist
Applies when PT/OT conducts mobility evaluation as part of the F2F encounter.

RESNA ATP

2 ▾

RESNA-certified ATP involvement for applicable wheelchair groups.

The wheelchair is provided by a supplier that employs a RESNA-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the beneficiary. pp. 3-5 (Group 2 SPO II.4, Group 2 MPO III.4, Group 3 IV.D, Group 5 VII, Push-rim VIII.D)
Required for Group 2 SPO/MPO, any Group 3, Group 5, and push-rim power assist.
The PT, OT, or practitioner performing the specialty evaluation may have no financial relationship with the supplier. pp. 3-5

ORDER REQUIREMENTS The physician order must contain specific elements. ▾

Incomplete orders are automatically denied.

Written Order Prior to Delivery (WOPD)

5 ▾

A standard written order is required prior to delivery for PMD base items.

Power Mobility Device bases require a Standard Written Order (SWO) prior to delivery (WOPD) for the base item. pp. 4, 18-19
The WOPD for the base item may only be written after the completion of the face-to-face encounter requirements. p. 19
The treating practitioner who completes the face-to-face requirements must be the same practitioner who writes the order/prescription for the PMD (base item). p. 19
If the supplier does not receive the order/prescription for the base item prior to delivery, the claim will be denied as not reasonable and necessary. pp. 18-19
The WOPD for the base item must be written on or after the date of the face-to-face encounter. p. 19

Order Forwarding Timeline

1 ▾

The 7-element order must reach the supplier within 45 days of the face-to-face encounter.

For power mobility devices, the 7-element order must be forwarded to the supplier within 45 calendar days after the face-to-face encounter is completed. p. 19

Order Before Delivery

1 ▾

The written order must be received by the supplier before the equipment is delivered.

The supplier must receive the completed standard written order (WOPD) before delivering the power mobility device to the beneficiary. p. 18

Select the equipment category. Check billing pathway and LCD documentation requirements. Get a claim readiness determination.

Sample PMD Case (Pre-loaded)

Synthetic PMD packet. No patient data. Evidence sections are pre-filled from a sample case with realistic gaps, timing failures, and contradictions. Scroll through the factors, then click Check Documentation Against LCD Requirements to run the real verification engine.

Deterministic checks for LCD factors, timelines, required elements, and cross-document contradictions.

No signup. You can rerun this synthetic sample case directly.

Public demo only. Do not submit real patient information here. Privacy Policy and Terms.

Suggested Demo Path

Review the pre-loaded sample packet details below.

Click Check Documentation Against LCD Requirements to run the full verification.

Read the findings first, then optionally edit a section and re-check.

Optional: Optional: adjust a timing or documentation section and use Update and Re-check to see how the report changes.

Claim Routing

Beneficiary's permanent residence (SSA address). Determines which DME MAC processes this claim.

Click to upload PDFs or drop files here

Upload all clinical documents: progress notes, physician orders, therapy logs, CMNs, F2F notes

You can select multiple files. All processing happens in your browser.

Check Documentation Against LCD Requirements

Confirm each documentation requirement for the selected equipment category. The readiness summary shows whether the claim can be submitted.

Key CMS Coverage Principle

A power mobility device is covered when the beneficiary has a mobility limitation that significantly impairs their ability to participate in one or more mobility-related activities of daily living (MRADLs) in the home, and a PMD is determined to be medically necessary.

p. 1

Start from the denial language, map what it appears to challenge, then compare that against what the chart actually documents.

Start from a Denial

Paste the denial reasoning below. The workspace identifies the coverage factors the denial appears to challenge, then lets you enter what the chart shows for those factors before running review.

Reverse Review Flow

1 Paste the denial reasoning only, not the full letter or appeal rights boilerplate.

2 The workspace maps which coverage factors the denial appears to challenge.

3 Enter what the chart actually documents for those factors so the report can compare denial reasoning to chart support.

Denial Reasoning

Include the reasoning section only. Exclude patient details and appeal instructions. Where do I find this?

Accepts denial letters, DENC reasoning, or any coverage determination text.

Patient identifiers are not needed. Remove names, dates of birth, and member IDs before pasting.

I agree to the Terms of Service

By using this tool you agree to our Terms of Service

Public PMD demo only. This sample case is synthetic. Do not submit real patient information here. Preview state and generated output are stored temporarily so the result can load and download. See our Privacy Policy and Terms of Service.

Checking against Medicare policy...

Checked against: Medicare DMEPOS Coverage Policy

Medicare LCD: Power Mobility Devices · 22 pages

View Requirements

Account Settings

Loading account data...

This tool helps determine whether the chart rebuts the denial and, secondarily, whether the denial reasoning aligns with the provided coverage policy. It does not provide legal advice or replace professional judgment.

This workspace reviews DME documentation against the selected Medicare coverage requirements. It does not assess medical necessity or make coverage determinations.

Three tools are available:

Check Documentation verifies your clinical descriptions against each coverage factor required by the active Medicare policy.
Evidence Locator scans a clinical PDF in your browser to find pages relevant to each coverage requirement. No upload.
Check Submission verifies denial reasoning against the coverage policy.

Select your equipment category and jurisdiction above. The workspace loads the matching policy automatically.

Coverage cases track verification history over time. Each case stores snapshots from coverage checks and denial reviews.

Add a case: Click "+ Add Case" in the sidebar. Enter a case label (required). Do not use patient names or MRNs.
Open a case: Click any case in the sidebar to load its latest report. If no check has been run, the form opens.
Update: Click "Update and Re-check" on any report to revise your descriptions and re-verify.
Edit label: Click the edit icon on a case row in the sidebar.
Archive: Click the archive icon. Archived cases are removed from the active list.
Delete: Click the delete icon. This permanently removes the case and all its snapshots.

Cases are sorted by coverage readiness: cases needing attention appear first.

Enter de-identified clinical descriptions for each CMS coverage factor. The system checks whether your descriptions meet the policy requirements.

Coverage factors are organized by tier. Expanding any tier reveals the next tier.

Readiness levels:

Documented means the description meets the CMS coverage factor.
Needs Support means the description does not fully address the requirement. The report shows the gap and a recommended addition.
Not Verified means no description was provided or the description could not be matched to the requirement.

Each gap includes the CMS standard (verbatim policy language), an explanation of what is missing, and a recommended addition.

Upload a clinical PDF (medical record, progress notes, therapy reports). The tool scans every page locally in your browser to find text relevant to each CMS coverage factor.

Your PDF never leaves your computer. The Evidence Locator scans pages entirely in your browser. When you submit the coverage check, the descriptions you confirmed or typed are sent to the server for policy verification. The original PDF file is never uploaded.

Matches show relevant text found on specific pages with a confidence indicator.
Confirm a match to include that evidence in your coverage check descriptions.
Dismiss a match if it is not relevant.
Start Over resets the Evidence Locator so you can upload a different file.

After confirming matches, click "Confirm and Continue" to populate the Check Submission form with the located evidence.

Paste the denial reasoning text (not the entire letter). The system first checks whether the chart rebuts the challenged coverage factors and then shows any policy leverage against the denial.

The denial review is organized in this order:

Appeal Room: Shows whether the chart currently rebuts the challenged denial factors.
Denial Claims vs Chart Rebuttal: Maps the denial to coverage factors and shows the chart support entered for each one.
Policy Leverage: Highlights contradictions, divergence, or outside criteria that strengthen the appeal.
Confirmed in Policy: Still available as context, but not the lead appeal question.

The main question is not just whether the denial sounds like Medicare. The main question is whether the chart gives you room to appeal the challenged factors.

Generate a Coverage Review Packet PDF for Triple Check or Utilization Review meetings.

The packet includes:

Cover page with summary statistics (total cases, readiness distribution)
Roster table sorted by coverage readiness (weakest cases first)
Per-case detail pages with factor status, last checked date, and change history

Click "Meeting Packet" in the sidebar to generate. The PDF opens in a new tab for printing.

The packet is a measurement summary. It does not constitute medical advice or coverage determinations.

Case labels: Use internal tracking labels (e.g. "Case 2024-031" or "Bed A3"). Do not enter patient names, MRNs, or room numbers.
Page references: Page numbers in reports link directly to the CMS policy PDF at that page. Click any page reference to view the source.
Printing reports: Use your browser's print function (Ctrl+P / Cmd+P). Reports are formatted for light backgrounds when printed.
Denial text: Paste only the denial reasoning section, not the entire letter. Skip patient identifiers and appeal rights boilerplate.
Service type: Changing the service type in the sidebar reloads the workspace with the matching CMS policy.

Billing Pathway

Mobility Limitation

Device Justification

Failed Less Costly Alternatives

POV-Specific Criteria

PWC-Specific Criteria

Face-to-Face Examination

Specialty Evaluation

Home Assessment

LCMP Concurrence

RESNA ATP

Written Order Prior to Delivery (WOPD)

Order Forwarding Timeline

Order Before Delivery

Check Documentation Against LCD Requirements

Start from a Denial

What does the chart actually show for the challenged factors?

Account Settings