- The beneficiary has a mobility limitation that significantly impairs his/her abilities to participate in one or more Mobility Related Activities of Daily Living (MRABL’s) in the home (toileting, feeding, dressing, grooming and bathing). A mobility limitation is one that prevents one from accomplishing MRADLs, or causes a heightened risk of illness/injury or death secondary to the attempts to participate in MRALs, or prevents one from completing MRADLs within a reasonable time frame. In addition, equipment may be covered if other conditions limit the ability to participate in MRADLs (e.g., impaired cognition or vision).
- The beneficiary/caregiver is able to use the equipment safely.
- A walker or cane is not sufficient.
- The home environment must be able to support the use of the equipment.
- Physician chart notes and/or a PT/OT assessment documents: The beneficiary’s medical history including use of other equipment, mobility limitations and ability to operate equipment, mobility limitations and ability to operate equipment safely must be documented.