CERTIFICATE
OF MEDICAL NECESSITY QUESTIONS
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NOTE: Questions in
this section should be answered accurately
to reflect the true condition of the
patient. Your answers to specific
questions are used by Medicare to
establish whether specific items are
reimbursable.
Questions 1: Patients
who require and use a wheelchair to
move around in their residence qualify
for Medicare reimbursement.
Question 2: Patients
who have quadriplegia qualify for
Medicare reimbursement for reclining
back feature.
Question 3: Patients
who have a cast, brace or musculoskeletal
condition, which prevents 90 degree
flexion of the knee, or have significant
edema of the lower extremities that
requires an elevating leg rest, qualify
for Medicare reimbursement for elevating
leg rest(s).
Question 4: Patients
who have a need for arm height different
than that available using non-adjustable
arms qualify for Medicare reimbursement
for adjustable armrests.
Question 5: Patients
who spend a minimum for two (2) hours
per day in the wheelchair qualify
for Medicare reimbursement.
Question 8 & 9: Answer
per patients evaluation.
NOTE: An Ultra lightweight
Wheelchair is rarely medically necessary
for the patient to perform covered
activities. Coverage is determined
on an individual consideration basis.
NOTE: Patients who
weigh more that 250 pounds or have
severe spasticity qualify for Medicare
reimbursement for a Heavy Duty Wheelchair.
Include the patient's height and weight
on the CMN.
NOTE: Patients who
weigh more than 300 pounds qualify
for Medicare reimbursement for an
Extra Heavy Duty Wheelchair. Include
the patient's height and weight on
the CMN.
NOTE: Supporting
documentation from the physician is
recommended.
Information courtesy of Health-E-Quip
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