Can Medicare Cover a Walker and Wheelchair Simultaneously?

If you require mobility assistance at home, you may wonder whether Medicare can cover both a walker and a wheelchair at the same time. Understanding Medicare’s rules for walkers, wheelchairs, and scooters as durable medical equipment can help clarify if simultaneous coverage is possible.

Medicare Coverage for Walkers

Medicare Part B covers walkers as a type of durable medical equipment (DME) if certain conditions are met:

• Your doctor submits a written order stating you have a medical need for a walker for use in your home.

• You have a health condition causing impaired mobility and limited ability to perform activities of daily living without assistance.

• You’re capable of safely using the walker within your home.

• The doctor prescribing the walker and the supplier accept Medicare assignment.

• The supplier verifies the walker can be properly used within your home environment.

Walkers covered by Medicare include standard walkers, rolling walkers with seats, and other specialty walkers. Medicare will pay 80% of the Medicare-approved cost after you meet your annual Part B deductible.

Medicare Coverage for Wheelchairs

Medicare also covers wheelchairs as DME if specific criteria are met:

• Your doctor submits documentation you medically require a wheelchair for in-home use.

• You cannot ambulate safely at home with a cane or walker.

• You’re physically and cognitively able to use the wheelchair safely.

• The doctor and supplier are enrolled in Medicare.

• The supplier verifies the wheelchair can be properly used in your home.

Covered wheelchairs include manual, power, and specialty models depending on your medical needs and mobility limitations. Medicare pays 80% of the Medicare-approved cost after your annual deductible.

Can Medicare Cover Both Simultaneously?

Whether Medicare will pay for a walker and wheelchair at the same time depends on your specific medical needs:

• If the walker and wheelchair serve different medical purposes, Medicare can cover both simultaneously. For example, if you use a walker for stability walking short distances but require a wheelchair for prolonged mobility, Medicare can approve claims for both in the same month.

• If you solely need the walker or wheelchair, Medicare will only cover whichever device your doctor prescribes as medically necessary. You generally can’t get both items for the same purpose.

• If you need both temporarily, Medicare can cover a wheelchair while recovering from a surgery or illness and later cover a walker as your mobility improves. Concurrent coverage usually won’t be approved for prolonged periods.

• If you need two items for safety, Medicare may cover a walker for indoors and a wheelchair for outdoors. Documentation must justify medical necessity.

• If you need portability, Medicare may cover both a manual wheelchair for indoor mobility and a power scooter for outdoor independence.

Securing Coverage for Dual Devices

To obtain Medicare coverage for concurrent walker and wheelchair claims, follow these steps:

• Get your doctor’s order: Your physician must document your medical need for each device in separate written DME orders.

• Prove homebound status: Your doctor must confirm you’re essentially confined to your home to qualify for the in-home coverage benefit.

• Verify with your supplier: Ask if they require extra documentation to submit simultaneous walker and wheelchair claims to Medicare.

• Consider an Independent Medical Exam: Medicare may request an exam by an independent physician to further validate your necessity for both devices.

• Check your state Medicaid plan: If you have Medicaid, check if they will cover all or part of the 20% Medicare doesn’t cover for the walker and/or wheelchair.

• Appeal denials: If Medicare denies either device, ask your supplier for help filing an appeal and provide additional supportive medical records.

With appropriate documentation from your doctor, dual walker and wheelchair claims have a stronger chance of getting approved. Be prepared to justify the medical need for both items.

Other Important Medicare Rules

If Medicare agrees to cover both a walker and wheelchair for you, be aware of these additional guidelines:

• The walker and wheelchair must be intended for repeat, long-term use per Medicare requirements for DME coverage.

• You pay 20% of the Medicare-approved amount for each device after meeting your annual Part B deductible.

• Medicare applies KX coverage modifiers to claims for dual devices expected to be required for 6 months or longer.

• You must get the walker and wheelchair from contract suppliers enrolled in Medicare if your area has Competitive Bidding.

• Medicare won’t cover repair costs for improperly used or intentionally damaged devices.

Following all Medicare regulations helps ensure continued claims payment for both your walker and wheelchair.

Seek Professional Guidance

The process of qualifying for simultaneous walker and wheelchair benefits can be complex. Consult with your physician, supplier, and a Medicare expert if you require two mobility devices to maximize your chances of approval. With proper documentation and persistence, obtaining coverage is possible.