Manual Wheelchairs

Standard Lightweight Wheelchairs are the classic wheelchairs that often come to mind. Many models weigh under 30 pounds, making them easier to push or propel. These wheelchairs can be self-propelled or pushed by a caregiver. When planning to load the wheelchair into a vehicle, it’s important to consider the chair’s weight and whether the rear wheels are detachable. Additionally, many of these wheelchairs offer customizable options, such as various seat widths and leg and armrest configurations.

BASIC WHEELCHAIR

Rhythm or Proactive Wheelchairs

Strongback Wheelchair

OUR MOST POPULAR SELLING WHEELCHAIR!

Feather Wheelchair

One of the Lightest Wheelchairs In The World! ONLY 13.5 lbs

So Lite C2 Ultra Wheelchair

ONLY 14 lbs

Other Wheelchair Options

Transport Wheelchairs

Details Coming Soon

Heavy Duty/High Weight Capacity Wheelchairs

Details Here

Reclining Back Wheelchairs

Details Coming Soon

Rehab Shower Commode Chairs

Details Coming Soon

MANUAL WHEELCHAIR DOCUMENTATION PROCESS

STEP 1 – SCHEDULE A FACE-TO-FACE OFFICE VISIT WITH THE ORDERING PHYSICIAN- REFERENCE GUIDE
STEP 2 – ORDERING PHYSICIAN COMPLETES THE STANDARD WRITTEN ORDER (SWO)

STEP 3 – FAX SWO AND CHART NOTES FROM PATIENT’S FACE-TO-FACE MOBILITY EXAM TO 704-821-7777

(email orders to info@mobility-more.com)

ONCE WE RECEIVE THE DOCUMENTATION ABOVE WE WILL SUBMIT TO MEDICARE/INSURANCE COMPANY FOR PRIOR AUTHORIZATION.

WE NORMALLY HEAR BACK FROM MEDICARE/INSURANCE COMPANY WITHIN 10-14 BUSINESS DAYS WITH A DECISION.

Information for Prescribing Manual Wheelchairs - Determining your Patients' Mobility Needs

Once you’ve determined from the face-to-face mobility evaluation that your patient’s mobility needs would best be served with a manual wheelchair, you’ll need to provide the following documentation within 45 days of your face-to-face mobility evaluation:

Prescription/7 Element Written Order for a manual wheelchair
Chart notes that detail the patient’s mobility need and a written summary of the face-to-face evaluation
Once the supplier has determined the specific wheelchair that is appropriate for the patient based on the physician’s order, the supplier must prepare a written document (termed a detailed product description) that lists the specific base (HCPCS code and either a narrative description of the item or the manufacturer name/model) and all options and accessories that will be separately billed. The physician must sign and date this detailed product description and the supplier must receive it prior to delivery of the wheelchair.

The face-to-face examination report must address the following:

Patient’s mobility limitation and how it interferes with the performance of activities of daily living
Why can’t a cane or walker meet this patient’s mobility needs in the home?
How will a manual wheelchair meet this patient’s mobility needs in the home?
Is the patient willing and capable of safely operating the manual wheelchair in their home?

The Standard Written Order (SWO) must include:

Order Date
Beneficiary’s (patient’s) first and last name
Beneficiary’s Date of Birth
Detailed description of the item that is ordered
Date of the face-to-face examination
Pertinent diagnosis/conditions that relate to the need for a wheelchair
Length of time the patient will need the device
Quantity of item being ordered
Physician’s signature
Date of physician’s signature

The report shall provide pertinent information about the following elements, but may include other details.1

Symptoms & related diagnoses
How long the condition has been present
History & clinical progression
Interventions (including medications) that have been tried and the results
Past use of a cane, walker, or other mobility aid and the results
Physical exam & weight
Impairment of strength, range of motion, sensation or coordination of arms and legs
Presence of abnormal tone, deformity of arms, legs or trunk
Neck, trunk, and pelvic posture and flexibility
Sitting and standing balance
Functional assessment – problems performing the following activities including the need to use a cane, walker or aid of another person:
- Transferring between a bed or chair and power mobility product
- Walking to & from the bathroom, kitchen, living room, etc.
- Distance patient is able to walk without stopping; speed, and balance
The elements that are addressed will depend on the diagnoses that are responsible for the mobility deficit. For example, for patients with COPD, heart failure or arthritis, the major emphasis will be on symptoms and history of the progression of their condition rather than on the physical examination.

Functional Assessment

Physicians shall also provide reports of pertinent laboratory tests, x-rays, and/or other diagnostic tests (e.g., pulmonary function tests, cardiac stress test, electromyogram, etc.) performed in the course of management of the patient. Although patients who qualify for coverage of a power chair may use that device outside the home, because Medicare’s coverage of a wheelchair is determined solely by the patient’s mobility needs within the home, the examination must clearly distinguish the patient’s abilities and needs within the home from any additional needs for use outside the home. Physicians shall document the evaluation in a detailed narrative note in their charts in the format that they use for other entries. The note must clearly indicate that a major reason for the visit was a mobility evaluation.

***Physicians will be provided an additional payment, using code G0454, for signing/co-signing the face-to-face encounter of the PA/NP/CNS. The physician should not bill the G code when he/she conducts the face-to-face encounter. Note that the G code may only be paid to the physician one time per beneficiary per encounter, regardless of the number of covered items documented in the face-to-face encounter.

Charlotte, NC Showroom 2301-A Crownpoint Executive Dr. Charlotte, NC 28227 704-821-7777 Ext. 101 Hours of operation Monday - Friday 10:00am - 5:00pm

704-821-7777 ext 101

info@mobility-more.com

Medicare/Private Insurance

NC Medicaid Insurance

Patient Information

First Name

Last Name

Item(s) Being Requested

Home Address

Cell Phone #

Patient Email

Patient Height

Patient Weight

Primary Contact Person

Primary Contact Cell Phone

Primary Contact Person Email

Insurance Information

Medicare ID #

NC Medicaid #

Private Insurance or Medicare Advantage Plan ID #

Physician Information

Ordering Physician

Physician Phone #

Physician Fax #

Additional Info

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