Electric Wheelchair and Power Operated Vehicles

Electric wheelchairs are motorized wheelchairs used for people who are unable to walk and have upper extremity impairment. 

Power operated vehicles are three or four wheel non-highway motorized devices, such as a scooter, used for people with impaired ambulation.  The medical need for these devices must be established by documenting that the enrollee has significant symptoms that affect mobility and impair ambulation.

Electric wheelchairs and power operated vehicles are not considered medically necessary when the underlying condition is reversible and the length of need is less than three (3) months duration.

The following guidelines are used when determining the medical necessity of electric wheelchair and power operated vehicle requests include physician-certified documentation that:

1. The enrollee’s mobility limitation cannot be resolved by the use of an appropriately fitted cane or walker.

2. The enrollee does not have sufficient upper extremity function to safely self-propel a manual wheelchair due to limitations such as reduced strength, endurance, range of motion, and coordination, or the presence of pain, deformity, or absence of one or more upper extremities.

3. The enrollee has the physical and mental capabilities needed to safely operate the electric wheelchair or power operated vehicle.

4. The enrollee’s condition is irreversible and the electric wheelchair and power operated vehicle is needed for greater than three (3) months.

5. The use of an electric wheelchair or power operated vehicle will significantly improve the enrollee’s routine ability to participate in mobility-related activities of daily living such as toileting, feeding, dressing, grooming, and bathing.

6. The enrollee’s home environment provides adequate space and layout to safely maneuver an electric wheelchair or power operated vehicle.

7. The enrollee’s weight does not exceed the weight capacity of the electric wheelchair and power operated vehicle being requested

8. The enrollee is agreeable to the use of an electric wheelchair or power operated vehicle.

Approved:  11/10

Revised:

Reviewed: 2/11, 1/12, 1/13, 3/14, 1/15, 1/16, 1/17, 1/18, 1/19, 2/20