Insurance Information For Scooters
Medicare Criteria for Scooters (HCPCS Code E1230)
To be considered medically necessary, the following coverage criteria must all be met:
- The patient is unable to operate a manual wheelchair.
- The patient is capable of safely operating the controls for the scooter.
- The patient can transfer safely in and out of the scooter, and have adequate trunk stability for safety.
- The patient's condition must be such that a POV is required for the patient to get around in his or her residence. A POV that is beneficial primarily in allowing the patient to perform leisure or recreational activities will be denied as not medically necessary.
If you are banking on the fact that you will be reimbursed by Medicare, but you want a little extra assurance before you purchase the scooter or electric wheelchair, you can file for pre-approval from Medicare. However, Medicare states that "if the review personnel make an "authorized" decision, this does not guarantee payment by Medicare for the product. An "authorized" determination is confirmation that the patients condition as described meets the criteria defined in the DMERC medical policies for the specified item."