Updated Guidance for Power Mobility Devices (PMD), CR 124323

Jun 04, 2024

Medicare has updated the documentation guidelines on PMDs, which include Power Operated Vehicles (POV) and Power Operated Wheelchairs (POW). Until such a time as the MaineCare Benefits Manual (MBM), Section 60.08-8(C) is updated, the Prior Authorization (PA) department will review PA requests consistent with the updated requirements that will also be included in the PA criteria sheet located on the Health PAS online portal. Updated PA criteria includes:

• Documentation of adequate trunk stability applies to POVs only and does not apply to POWs. Documentation indicating a member is able to safely transfer in and out of the PMD is still required for both types of devices.
• A qualifying face-to-face encounter with a treating practitioner must occur within the six (6) months prior to the date of the Written Order Prior to Delivery (WOPD).

The following requirement is no longer included:

• A qualifying face-to-face encounter with a treating practitioner must occur within 45 days prior to the date of the WOPD.
• There is no longer a requirement for a letter from the physician stating a member’s condition is not expected to deteriorate significantly for three (3) years for POVs.

If you have any questions regarding the coverage of PMDs, please reach out to your Provider Relations Specialist Shannon Beggs.