Now, in order to get a motorized W/C from Medicare, they require a PT eval for the need for motorized chair
This is partially due to fraud and abuse Medicare uncovered for motorized equipment. Many HMO's also requesting PT.
Different PT company not associated with DME company requested to perform eval. I take usually one referral a week for this type eval.
PT will eval for:
a. If patient DX/ medically necessity is appropriate for equipment AND are they able to cognitively use equipment.
b. Home adaptation:
Can electric scotor be used inside home, doorways wide enough? Is there a way to get scotter out of the home for community use (not 12 steps to enter /exit, lol) OR does patient need to be referred to community program for ramp to home?
c. Measure client for proper WC fit based on ht, wt, seating needs( hips and leg length), weight and special needs.
d. Our PT's also identify if patient could benefit from in-home PT for strengthening, transfer training, gait abnormalaties etc at time of visit.
Too often DME companies got a doctor to write RX, sold equipment, didn't fit client or client still stuck in home and equipment sat unused.
RE lift chair:
1. Must have letter of medical necessity.
2. MC will only pay for motorized part (~1/2 cost of chair), other part billable to patient.
3. Also need to eval HT and WT.
4. If client also has HMO or MA secondary, they will usually pick up remainder of cost.
RE PT referral in general
Very helpful when requesting PT referral , to identify WHY PT being requested so appropritate problem identified.
Potential Needs for PT:
Ambulatory dysfunction-gait training
Home safety eval
Eval need adaptive equipment
ADL training ( BR and kitchen-----request OT EVal)
Prosthetic training and fitting:esp if wt loss/gain
Improving bed mobility--especially if client homebound and hasn't seen PT in a while, good for review of body mechanics to prevent shearing when moving
Stump wraping, pylon training
Equipment eval: walker, need for wheels; WC seating, transfer equipment-------is any part broken, worn out and needs replacement??