Power Mobility Billing Services
Power wheelchair and scooter billing for DME suppliers, built around the paperwork Medicare wants to see before the chair ever leaves your warehouse.
- Face-to-face encounter and order review
- Prior authorization requests
- Specialty evaluation and ATP documentation checks
- Denial work and appeals
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HIPAA compliant. We never share your data.
Why suppliers hand us their power mobility billing
- 99.9% accuracy on the claims we work
- 97% collection rate
- We work inside Brightree, Bonafide, NikoHealth or TIMS
- HIPAA compliant handling of patient data
- ISO 9001 and ISO 27001 certified
- Each payer’s mobility rules kept in your billing setup
A power chair claim is decided before delivery
With power mobility, the order of events matters as much as the documents. The treating practitioner holds a face-to-face encounter focused on mobility, and only after that can they write the order for the base, called a written order prior to delivery. That order has to come within six months of the encounter, and the same practitioner who did the encounter has to write it. You must have the order in hand before the device is delivered.
The encounter note has to answer four questions. What can’t the patient do at home? Why won’t a cane or walker solve it? Why won’t a manual wheelchair? And for a power wheelchair, why isn’t a scooter enough? We read the note against those questions before anything is submitted.
Prior authorization, home assessment and the extra steps for complex chairs
Medicare requires prior authorization nationwide for power wheelchairs and scooters on its required list, including the K0800 to K0808 scooter codes and the Group 1, 2 and 3 power wheelchair codes. Deliver without an affirmed request and the claim is denied. An affirmation stays valid for six months, so delivery has to happen inside that window or the request starts over.
Before or at delivery, the supplier or practitioner also has to check the home in person and confirm the patient can move the device through it, looking at layout, doorway widths, thresholds and floor surfaces. That report has to be written down and available on request.
Group 2 power option chairs, every Group 3 chair and power assist systems have two more requirements. First, a specialty evaluation by a PT, OT or practitioner who has wheelchair training and no financial tie to the supplier. Second, in-person involvement from a RESNA-certified Assistive Technology Professional employed by the supplier.
HCPCS codes we bill
| HCPCS | Description |
|---|---|
| K0800 to K0802 | Power operated vehicle (scooter), Group 1, by patient weight capacity |
| K0813 to K0829 | Power wheelchair, Group 1 and Group 2 bases (for example K0823, Group 2 standard, captains chair, up to 300 lb) |
| K0835 to K0843 | Power wheelchair, Group 2 with single or multiple power options |
| K0848 to K0864 | Power wheelchair, Group 3 bases, including single power option K0856 to K0860 and multiple power options K0861 to K0864 |
| E0986 | Manual wheelchair accessory, power assist system |
Billing systems we work in
We log in to the system you already use. No migration, no new software for your team.
How we run your power mobility billing
Before the claim
- Encounter and order review: we check the face-to-face note, the order date, the practitioner match and the six-month window.
- Packet build: we pull together the order, encounter, specialty evaluation, LCMP attestation and ATP proof where the chair requires them.
- Prior authorization: we submit the request, follow it to a decision and track the six-month delivery window once it’s affirmed.
After the claim
- Claim submission: the base and any separately billed options go out with the right codes, the separate order for accessories and the rental or purchase modifiers that fit the device.
- Payer rules: commercial and Medicare Advantage plans set their own authorization steps. We keep each plan’s rules on its own.
- Denial follow-up: we work denials by root cause and feed the fix back into intake.
Your patient data stays protected
We handle patient records under HIPAA and an ISO 27001 certified information security program. We work in your own billing system, so your data stays where it already lives.
What changes when we take over
- Fewer non-affirmations. Packets are checked against the LCD before they’re sent.
- No new software. We work in Brightree, Bonafide, NikoHealth or TIMS.
- One team. One team for complex rehab and the rest of your DME billing services.
High-value claims sit in A/R the longest. Read our A/R recovery case study.
Frequently asked questions
How soon after the face-to-face encounter must the order be written?
The encounter has to take place within six months before the order date, and the practitioner who held the encounter has to write the order for the base. The supplier needs that order before delivery.
Do power wheelchairs need prior authorization from Medicare?
Yes. The power wheelchairs and scooters on the CMS required prior authorization list need an affirmed request before delivery. The affirmation is valid for six months.
Is a home assessment required?
Yes. Before or at delivery, the supplier or practitioner must check the home in person to confirm the patient can use the device given the layout, doorways, thresholds and surfaces, and keep a written report.
Is the old 7-element order still required?
No. Medicare replaced the 7-element order for power mobility devices with the standard written order, effective January 1, 2020. For the base, that order must be received before delivery.