B. Other Walking Aids Not Sufficient
What Makes a Patient Eligible for a Manual Wheelchair?
A patient qualifies for a manual wheelchair when ALL of these conditions are met:
A. Mobility Limitation
The patient has a significant limitation in their ability to perform one or more Mobility-Related Activities of Daily Living (MRADLs) in their home:
What Are MRADLs?
- Toileting
- Feeding
- Grooming
- Bathing
The limitation must EITHER:
- Completely prevent the activity, OR
- Place the patient at heightened risk of morbidity/mortality when attempting the activity, OR
- Prevent completion within a reasonable time
B. Other Walking Aids Not Sufficient
- A cane or walker cannot sufficiently resolve the mobility limitation
C. Home Environment Allows Use
- The patient's home provides adequate access between rooms
- There is sufficient maneuvering space
- Surfaces accommodate wheelchair use
D. Patient Can Use Effectively
- The wheelchair will significantly improve their ability to participate in MRADLs
- They will use it regularly in the home
E. Patient is Willing and Able
The patient must EITHER:
- Have sufficient upper body strength and mental/physical capability to safely self-propel, OR
- Have a caregiver who is available and able to assist with the wheelchair
How to Document Medical Necessity
Required Elements in Medical Record:
1. Detailed physical examination that includes:
- Upper body strength assessment
- Range of motion
- Sitting balance
- Cognition/judgment
2. Functional assessment describing:
- Specific MRADL limitations
- Why cane/walker is insufficient
- How wheelchair will improve function
- Description of home accessibility
3. Relevant diagnoses and symptoms:
- Primary condition causing mobility limitation
- Associated symptoms affecting mobility
- Other conditions impacting equipment needs
Documentation Tips
- Use objective measures whenever possible
- Describe activity limitations in detail
- Include duration of need
- Document failed attempts with other mobility devices
- Note specific home layout/accessibility
- Include caregiver assessment if applicable
Common Documentation Errors to Avoid
- Vague descriptions of limitations
- Missing objective measurements
- No documentation of cane/walker insufficiency
- Lack of home assessment
- Missing strength/ROM assessment
- No documentation of caregiver ability when required
Need Help?
We provide detailed documentation templates and examples for specific conditions. Contact us for:
- Condition-specific templates Sample narratives
- Documentation checklists
- Pre-review of documentation
