How to Get Evaluated for a Custom Power Wheelchair - Part 5

If your loved one is struggling to get around or is at risk of pressure injuries, a custom power wheelchair may be the solution. But you can’t just order one online—Medicare requires a formal evaluation by a medical team.

Step 1: Get a Face-to-Face Visit With a Doctor

The first step is a visit with their primary care doctor, neurologist, or another specialist. The doctor must explain why a power wheelchair is medically necessary, not just for comfort, but for safety and function at home.

This visit must happen within 6 months of the wheelchair evaluation.

Step 2: Schedule a Seating Evaluation With a Therapist

Next, a physical or occupational therapist will perform a special evaluation—usually at a clinic or therapy center. This is called a “seating and mobility evaluation.”

The therapist will assess things like:

• Posture and strength
• Skin condition and pressure risks
• How the person moves and transfers
• Ability to operate a power chair safely

Step 3: Work With an ATP (Assistive Technology Professional)

The therapist and an ATP—a certified wheelchair expert—will work together to choose the right equipment. The ATP helps with measurements, trial chairs, and selecting features like tilt, recline, custom cushions, and joystick controls.

Step 4: Submit to Medicare or Insurance

Once the evaluation is complete, the ATP and DME provider (like us!) submit all paperwork to Medicare or your insurance company. This includes:

• Doctor’s notes
• Therapist’s evaluation
• ATP’s report and equipment recommendations

The process can take a few weeks. But once approved, your custom wheelchair is ordered, delivered, and adjusted just for your loved one.

Who Qualifies?

Medicare may cover a Complex Power Wheelchair with tilt and/or recline if the person:

• Has a neurological or neuromuscular condition (like stroke with hemiplegia, Parkinson's,  Spinal Cord Injury, ALS, MS)
• Is non-ambulatory and cannot shift weight independently
• Has a history or high risk of pressure injuries
• Is evaluated by a physical or occupational therapist and an ATP
• Unable to perform independent pressure reliefs during wheelchair use. 

Common diagnoses that may qualify under Medicare guidelines include:

If your loved one can’t shift their weight independently or has had a pressure injury before, it’s time to consider a seating system that protects their skin and improves their daily comfort and independence.

← Previous: The Role of Cushions and Backs in Skin Protection →
Next: “Delivering the Right Fit: What to Expect When Your Chair Arrives”

Need help getting started with the evaluation process?
Call us at (772) 277-7746 or visit our Complex Power Wheelchairs page to schedule your free consultation.  Ask for Jenee!