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272M Page 1 of 5 07/13 NEW HAMPSHIRE MEDICAID MOBILITY EVALUATION FORM This evaluation must be completed by a New Hampshire licensed physician, occupational therapist, or physical therapist specializing.

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The reason for the evaluation can be new equipment, replacement equipment or modifications to current equipment. An OT or PT works with wheelchair vendors to determine your mobility needs. The team creates a wheelchair prescription based on: Your goals, abilities and physical assessment. Skin safety.

A face-to-face mobility examination, sometimes referred to as an in-office mobility evaluation, is a required doctor's office visit. It is mandated by Medicare and must occur prior to receiving a power wheelchair prescription. Patient mobility must be the primary focus of the examination.

Power wheelchairs and power operated vehicles (also known POVs or scooters) are collectively classified as Power Mobility Devices (PMDs) and are covered under the Medicare Part B benefit. CMS defines a PMD as a covered item of DME that includes a power wheelchair or a POV that a beneficiary uses in the home.

Mobility-related Activities of Daily Living (MRADL s) means personal care activities including but not limited to tasks such as toileting, eating, dressing, grooming, and bathing.

What is a Wheelchair Assessment? A wheelchair assessment measures your clinical needs and a prescription is made for the right wheelchair for you. The assessment will take into account your lifestyle, your environment and the needs of your carers/PA family or whomever will be handling your wheelchair.

If you can't use a cane or walker, or can't operate a manual wheelchair, you may qualify for a power-operated scooter. To qualify, you must be able to get in and out of it safely and strong enough to sit up and safely operate the controls.

Wheelchair Assessment There's a Code for That!CPT® Code 97542 is described as Wheelchair management (eg, assessment, fitting, training), each 15 minutes and is used to assess a patient's need for a wheelchair as well as teaching the patient wheelchair maneuvering skills.

Medicare. Your Insurance Company. Grants and Charities. The American Outreach Foundation. Latter-day Saint Charities. Social Security and State Disability Assistance.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232