Does Medicare Pay for Wheelchairs and Walkers?

Medicare beneficiaries often seek clarity on coverage for essential mobility aids like wheelchairs and walkers. This article details how Medicare covers these durable medical equipment items, outlining eligibility criteria, necessary documentation, and steps for acquisition.

Medicare Coverage for Mobility Aids

Medicare Part B covers Durable Medical Equipment (DME) when prescribed by a healthcare provider for home use. DME refers to equipment that can withstand repeated use, serves a medical purpose, is generally not useful to someone without an illness or injury, and is expected to last for at least three years. Common examples of DME covered by Medicare include walkers, manual wheelchairs, and power wheelchairs.

A key condition for Medicare to cover DME, including mobility aids, is medical necessity. This means the item is required to diagnose or treat an illness, injury, condition, or its symptoms, and meets accepted medical standards. While primarily for home use, the equipment can also be used outside the home. Medicare pays for only one piece of DME for a particular health condition at a time, covering the most basic form needed.

For mobility aids like walkers and wheelchairs, Medicare Part B covers these items when prescribed by a Medicare-enrolled doctor or healthcare provider. This prescription signifies the equipment is required due to a medical condition or injury. Medicare Advantage plans are also required to cover the same medically necessary categories of DME.

Meeting Coverage Requirements

To qualify for Medicare coverage of a wheelchair or walker, a face-to-face examination with the treating physician or practitioner is a required step. It must occur within six months prior to the date the written order for the equipment is generated. During this examination, the practitioner evaluates the beneficiary’s condition and documents how it supports the need for the requested DME.

Following the examination, a written order from the prescribing physician is necessary. This order must include the beneficiary’s name, a general description of the item, quantity, the order date, and the treating practitioner’s name and signature. For wheelchairs and walkers, documentation must specify why the mobility limitation significantly impairs the beneficiary’s ability to perform mobility-related activities of daily living (MRADLs) in the home, such as toileting, feeding, dressing, grooming, and bathing.

The medical record must state why a cane or standard walker is insufficient to meet the beneficiary’s mobility needs within the home. For example, a rollator walker may be covered if a standard walker cannot address the mobility difficulties, or if a power wheelchair is needed, documentation must explain why manual options are not viable. The doctor must also document that the equipment is for use in the beneficiary’s home, and that the home environment provides adequate access and space for the device. For power wheelchairs, the physician must certify that the beneficiary is capable of safely operating the controls.

A Certificate of Medical Necessity (CMN) or DME Information Form (DIF) was historically required for certain DME items. However, for claims with dates of service on or after January 1, 2023, the Centers for Medicare & Medicaid Services (CMS) no longer requires the submission of CMNs or DIFs with claims for many DME items, as this information is now available on the claim or in the medical record. Despite this change in submission requirements, the underlying medical necessity criteria and the need for comprehensive documentation within the patient’s medical records remain in effect.

Acquiring Covered Mobility Aids

Once medical necessity requirements and documentation are met, beneficiaries can proceed with acquiring the approved mobility aid. It is important to obtain the equipment from a supplier enrolled in Medicare. Medicare-approved suppliers agree to accept Medicare’s approved payment amount, which helps to limit the beneficiary’s out-of-pocket costs. Beneficiaries should always confirm that the supplier accepts Medicare assignment before obtaining equipment.

After the Part B deductible is satisfied, Medicare covers 80% of the Medicare-approved amount for Durable Medical Equipment. For 2025, the annual Medicare Part B deductible is $257. The beneficiary is responsible for the remaining 20% coinsurance.

Medicare’s approach to payment for DME can involve either rental or purchase, depending on the specific type of equipment. Many items, including some manual and power wheelchairs, are initially rented. Medicare may allow a choice between renting or purchasing for certain items, such as some power wheelchairs or items costing less than $150. The supplier will submit the claim to Medicare, and beneficiaries will receive a Medicare Summary Notice detailing the services and costs.