Medicare Policy on Mobility Assistive Equipment

Medicare policies set the baseline for many other commercial and public funding sources. Furthermore, the specific policies on wheelchairs and their accessories define what is covered by the Medicare program and the conditions that are required to be met for coverage. The Medicare program publishes many policies on wheelchair coverage: 

National Coverage Determination: Mobility Assistive Equipment

Local Coverage Determination: Power Mobility Device Bases

Local Coverage Determination: Manual Wheelchair Bases

Local Coverage Determination: Wheelchairs Options/Accessories‍

Local Coverage Determination: Wheelchair Seating

There are also local coverage articles for power mobility and manual wheelchair bases, accessories and seating. While the difference between LCD and LCA are confusing, HCD Healthcare defines the difference as this: 

Local Coverage Determinations (LCDs) are decisions by a local Medicare Administrative Contractor and are applicable only within the issuing MAC’s jurisdiction(s). Like NCDs, LCDs generally describe the criteria and coverage limitations that apply to particular services, procedures or devices for coverage and payment purposes. Unlike NCDs, however, an LCD is binding only on the Medicare Contractor that issued the LCD and on the jurisdiction’s QIO; it is not binding on other Medicare Contractors, QIOs or ALJs. 

Local Coverage Articles (LCAs) are typically published by a local Medicare Administrative Contractor to provide coding/billing guidelines or other provider education that is complementary to an existing NCD or LCD. In some cases LCAs may be issued by MACs as independent policies. Similar to LCDs, LCAs apply only to the MAC that issued the Article. 

When looking for the policies about a Medicare beneficiary’s unique wheelchair, it is important to review the NCD, LCD, and LCA that are associated with their equipment needs.