Medicare Mobility Scooter Coverage: Rules, Costs and How Suppliers Bill

Medicare Part B covers a mobility scooter, which Medicare calls a power-operated vehicle (POV), when a treating practitioner orders it after a face-to-face exam and the record shows the beneficiary cannot get around the home with a cane, walker or manual wheelchair. The supplier must get prior authorization first, and the beneficiary pays 20% of the Medicare-approved amount after the Part B deductible.

This page explains the rules and the money. It is not medical advice. Whether a scooter fits a given person is for that person, their clinician and their supplier to decide.

The codes Medicare uses

Medicare does not have a “scooter” benefit. It pays for HCPCS codes. Medicare.gov lists six power-operated vehicle codes, all requiring prior authorization:

• K0800: Group 1 standard, patient weight capacity up to and including 300 pounds.
• K0801: Group 1 heavy duty, 301 to 450 pounds.
• K0802: Group 1 very heavy duty, 451 to 600 pounds.
• K0806, K0807, K0808: Group 2 standard, heavy duty and very heavy duty at the same weight breaks.

Policy Article A52498 sets the performance line between groups. A Group 1 POV must be “less than or equal to 48 inches” long with a minimum top speed of 3 MPH. A Group 2 POV must reach 4 MPH with a minimum range of 10 miles. That extra performance is the reason Group 2 is not covered: LCD L33789 says Group 2 POVs have capabilities not needed in the home and denies them as not reasonable and necessary. The CMS Operational Guide repeats that K0806 to K0808 “will be non-affirmed on prior authorization.”

The coverage criteria

LCD L33789 applies the same three basic criteria to every power mobility device, then adds six for scooters.

The basics (criteria A to C): the beneficiary has a mobility limitation that “significantly impairs his/her ability to participate in one or more mobility-related activities of daily living” (MRADLs) such as toileting, feeding, dressing, grooming and bathing in the home. The limitation “cannot be sufficiently and safely resolved by the use of an appropriately fitted cane or walker.” And the beneficiary “does not have sufficient upper extremity function to self-propel an optimally-configured manual wheelchair in the home.”

The scooter criteria (D to I): the beneficiary can safely transfer to and from the POV, “operate the tiller” and maintain postural stability in the home; has the mental and physical capability, including vision, to use it safely; lives in a home with adequate access, maneuvering space and surfaces; weighs within the device’s capacity and at least 95% of the next lower weight class’s capacity; will have MRADL participation significantly improved and will use the device in the home; and has not expressed unwillingness to use it in the home.

The weight rule has teeth. A 280-pound beneficiary does not qualify for a heavy duty K0801 even if the supplier stocks it, because 280 is under 95% of the 300-pound standard class capacity. The record must support the class billed.

Why a scooter is denied when a cane or walker suffices

The order of operations comes from the National Coverage Determination for Mobility Assistive Equipment, NCD 280.3. It directs “sequential consideration” of the beneficiary’s deficit: first whether a mobility limitation impairs an MRADL in the home, then whether a cane or walker, “appropriately fitted,” can resolve it, then whether the home supports a wheelchair, then whether the beneficiary can propel an optimally configured manual wheelchair, and only then whether the beneficiary “has sufficient strength and postural stability to operate a POV/scooter.”

A record that documents a diagnosis but not this sequence does not get affirmed. The DME MAC reviewer is looking for the face-to-face note to say why the lower rungs fail in this person’s home, not for a prescription that names a device.

The in-home criterion

Everything above is measured inside the home. Under 42 CFR 410.38, DME must be used “in the patient’s home or in an institution that is used as a home,” and that institution “may not be a hospital or a CAH or a SNF.” LCD L33789 requires the supplier or practitioner to “perform an on-site evaluation of the beneficiary’s home” before or at delivery, with a written report available on request.

Policy Article A52498 draws the hard line: “If any POV or PWC is only for use outside the home, it will be denied as noncovered.” A scooter wanted for the grocery store, the park or the church parking lot is not a Medicare benefit. The claim carries a GY modifier in that case, and Medicare pays nothing toward it.

Prior authorization and the order

Scooters joined the Required Prior Authorization List on April 13, 2022 nationwide, per the CMS Operational Guide and the CMS master list page for K0800. The same CMS page shows the face-to-face encounter and written order prior to delivery requirement for K0800 effective April 17, 2023. CMS’s comparison chart dated October 28, 2026 lists all six POV codes as “Nationwide” for both requirements.

The sequence the supplier must follow:

1. The treating practitioner (physician, PA, NP or CNS) holds a face-to-face encounter and documents the mobility evaluation.
2. The practitioner writes a Standard Written Order after the encounter, within 6 months of it, and sends it to the supplier before delivery. The six elements under 42 CFR 410.38(d): beneficiary name or MBI, item description, quantity if applicable, order date, practitioner name or NPI, signature.
3. The supplier submits the prior authorization request to the DME MAC. The MAC decides “within 5 business days (not to exceed 7 calendar days).” Expedited reviews target 2 business days. Resubmissions are unlimited.
4. An affirmed decision “will remain valid for six months.” The supplier completes the home assessment, delivers, keeps proof of delivery, and bills with the 14-byte Unique Tracking Number on the claim.

A claim filed without the process “will be denied,” per the guide.

What it costs

Medicare.gov puts the 2026 Part B deductible at $283. After that, “you pay 20% of the Medicare-approved amount” for durable medical equipment if the supplier accepts assignment. The approved amount is the Medicare fee schedule figure for the K code billed, which can differ from the supplier’s retail price.

Medicare.gov warns that a non-participating supplier may charge more and advises confirming that the supplier accepts assignment “for all rental months.” Medicare.gov describes scooters as items you “may need to rent” or “may need to buy,” and notes that some items “become your property after you’ve made a certain number of rental payments.” The capped rental rule in 42 CFR 414.229 caps rental at 13 months of continuous use and requires title transfer afterward. Ask the supplier which payment category applies to the specific code before signing.

Once owned, the device is replaceable under 42 CFR 414.210(f) after its reasonable useful lifetime (at least 5 years from delivery) or if lost, stolen or irreparably damaged. Repairs to beneficiary-owned equipment are paid under 414.210(e) for parts and labor not under warranty.

The supplier’s role

The supplier is the party Medicare pays, and the rules put most of the paperwork on it. Medicare.gov: “Medicare will only pay for DME items if you get them from suppliers who are enrolled in Medicare.” The supplier submits the prior authorization request, performs or arranges the home assessment, holds the signed written order before delivery, keeps proof of delivery, and bills with the KX modifier (or GA, GY or GZ) that A52498 requires on every PMD claim line.

For the beneficiary, that means three questions to ask any scooter supplier: Are you enrolled in Medicare? Do you accept assignment for every rental month? Has the prior authorization been affirmed, and what is the UTN?

Scooter versus power wheelchair in Medicare’s eyes

NCD 280.3 defines the difference by design. A POV is “a 3- or 4-wheeled device with tiller steering and limited seat modification capabilities.” A power wheelchair’s distinguishing features are “control by a joystick or alternative input device, lower seat height for slide transfers, and the ability to accommodate a variety of seating needs.”

The coverage consequence: LCD L33789 considers a power wheelchair only when the scooter criteria D through F are not met. A beneficiary who can transfer to a scooter, hold position and work a tiller, in a home that fits one, is a scooter candidate under Medicare rules, not a power wheelchair candidate. A beneficiary who cannot do those things moves to the power wheelchair criteria, which are covered in detail in the Medicare power wheelchair rules hub.

Medicare Advantage

Medicare Advantage plans “must cover all medically necessary services that Original Medicare covers,” according to Medicare.gov. The plan may require network suppliers and its own approval: “You may need to get approval (prior authorization) from your plan before it covers certain services or supplies.” Plans also set a yearly out-of-pocket limit. The LCD criteria on this page bind Original Medicare claims; a plan may publish its own policy. Get the plan’s scooter policy and supplier list in writing before ordering.

What changed recently

• October 28, 2026: CMS’s required lists comparison chart confirms all six POV codes (K0800 to K0808) require prior authorization nationwide and a face-to-face encounter with written order before delivery.
• September 2, 2026: CMS updated the DMEPOS Prior Authorization Operational Guide, restating that K0806 to K0808 are non-affirmed and that affirmed decisions are valid six months.
• January 1, 2026: The Part B deductible rose to $283 and the standard Part B premium to $202.90 a month.
• October 1, 2025: LCD L33789 revision R9 and Policy Article A52498 revision R19 took effect.
• April 17, 2023: The face-to-face and written order prior to delivery requirement took effect for K0800 to K0802, per the CMS master list pages.
• April 13, 2022: Scooter codes K0800 to K0802 and K0806 to K0808 joined the Required Prior Authorization List nationwide.

Where to check

• Medicare.gov: Wheelchairs & scooters
• Medicare.gov: Power wheelchairs that require prior authorization
• Medicare.gov: Medicare costs
• LCD L33789: Power Mobility Devices and Policy Article A52498
• NCD 280.3: Mobility Assistive Equipment
• CMS DMEPOS Prior Authorization Operational Guide (PDF)
• Noridian: Prior Authorization for PMDs

The treating practitioner and a Medicare-enrolled supplier can tell you where a specific case stands against these criteria.