Medicare Wheelchair Coverage: What Is Covered, Who Qualifies, What You Pay

Medicare Part B covers manual wheelchairs, power wheelchairs and scooters as durable medical equipment (DME) when a treating practitioner orders one for use in your home after a face-to-face exam. You pay 20% of the Medicare-approved amount after the Part B deductible, and most chairs are rented month to month for up to 13 months before you own them.

This page describes the rules. It is not medical advice. The decision about which device fits a given person belongs to that person, their clinician and their supplier.

What Medicare covers

Medicare.gov states that Part B covers “wheelchairs and power-operated vehicles (scooters) if you’re eligible.” The DME benefit applies to equipment your doctor or other health care provider “orders for use in your home.” Power models are covered only when medically necessary, and you must have a face-to-face examination and a written prescription from a treating provider before Medicare pays.

Three device classes sit under this benefit:

• Manual wheelchairs, coded K0001 through K0009 plus transport chairs (E1037 to E1039) and tilt-in-space bases (E1161). Coverage rules are in the DME MAC Local Coverage Determination L33788.
• Power-operated vehicles (scooters), coded K0800 to K0808. Rules are in LCD L33789.
• Power wheelchairs, Groups 1 through 5, coded K0813 to K0891. Rules are also in LCD L33789.

Who qualifies: the in-home test

Coverage turns on function inside the home. The National Coverage Determination for Mobility Assistive Equipment (NCD 280.3) covers these devices for beneficiaries with “a personal mobility deficit sufficient to impair their participation in mobility-related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing in customary locations within the home.”

LCD L33788 turns that into a checklist for a manual wheelchair. The beneficiary must have a mobility limitation that significantly impairs one or more MRADLs in the home. That limitation cannot be “sufficiently resolved by the use of an appropriately fitted cane or walker.” The home must have “adequate access between rooms, maneuvering space, and surfaces” for the chair. The chair must significantly improve participation in MRADLs and be used regularly in the home. And the beneficiary must either be able to self-propel it safely or have a caregiver “who is available, willing, and able to provide assistance.”

The regulation behind this, 42 CFR 410.38, says the equipment 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.”

The order and the face-to-face exam

Since January 1, 2020, every DMEPOS item needs a Standard Written Order. Under 42 CFR 410.38(d), the order must carry the beneficiary’s name or Medicare Beneficiary Identifier, a description of the item, the quantity if applicable, the order date, and the treating practitioner’s name or NPI and signature. The treating practitioner can be a physician, physician assistant, nurse practitioner or clinical nurse specialist.

Power mobility devices and other items on CMS’s Required Face-to-Face Encounter and Written Order Prior to Delivery List carry two extra conditions. The written order must reach the supplier before delivery. And the practitioner must document a face-to-face encounter “within the 6 months preceding the date of the written order/prescription.” The CMS comparison chart dated October 28, 2026 shows that every Group 1 to 3 power wheelchair code and every scooter code, the ultralightweight manual chair K0005, the manual codes K0002 through K0007, and the tilt-in-space base E1161 require the face-to-face encounter and the written order before delivery.

Manual first, then scooter, then power chair

Medicare does not let a beneficiary start at the top. NCD 280.3 sets out “sequential consideration” of questions: can a cane or walker resolve the deficit; does the home support a wheelchair; can the beneficiary propel an optimally configured manual wheelchair; can the beneficiary operate a scooter; are the additional features of a power wheelchair needed. LCD L33789 applies the same ladder. A power device is considered only when 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.” A power wheelchair is considered only after the scooter criteria fail.

Within manual chairs, the LCD matches the code to the need. A lightweight chair (K0003) requires that the beneficiary “cannot self-propel in a standard wheelchair in the home” and “can and does self-propel in a lightweight wheelchair.” A heavy duty chair (K0006) is covered for a beneficiary who weighs more than 250 pounds or has severe spasticity; extra heavy duty (K0007) for more than 300 pounds. An ultralightweight chair (K0005) requires a full-time manual wheelchair user, a specialty evaluation by a licensed or certified medical professional, and a supplier that employs a RESNA-certified Assistive Technology Professional directly involved in selection.

What you pay in 2026

Medicare.gov lists the 2026 Part B deductible at $283 and the standard Part B premium at $202.90 a month. After the deductible, “you pay 20% of the Medicare-approved amount” for DME if your supplier accepts assignment. Medicare pays the other 80%.

If the supplier does not accept assignment, it can charge more than the Medicare-approved amount. Medicare.gov’s advice: “If a supplier participates in Medicare, they must accept assignment.” For a rental, confirm the supplier will accept assignment “for all rental months.”

Rent or buy: capped rental

Wheelchairs fall under the capped rental payment rules in 42 CFR 414.229. Medicare pays a monthly rental amount “for no longer than a period of continuous use of 13 months.” The supplier must then “transfer title to the item to the beneficiary on the first day that begins after the 13th continuous month” of rental payments. Monthly rental is 10 percent of the purchase price for each of the first 3 months and 7.5 percent for the remaining months. For power wheelchairs furnished on or after January 1, 2011, the rates are 15 percent for the first 3 months and 6 percent after that.

One exception: an option to buy at the first month exists only for complex rehabilitative power wheelchairs. Since January 1, 2011, standard power wheelchairs are capped rental only. Two months before title transfers, the supplier must tell you whether it can maintain and service the chair afterward. Once you own the chair, Medicare pays for maintenance and servicing of parts and labor not covered by warranty under 42 CFR 414.210(e).

Suppliers, enrollment and assignment

Medicare.gov is direct: “Medicare will only pay for DME items if you get them from suppliers who are enrolled in Medicare.” The supplier submits the claim, and for power mobility devices the supplier usually submits the prior authorization request. For power devices, LCD L33789 also 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. Suppliers must keep proof of delivery on file.

Medicare Advantage

Medicare Advantage plans “must cover all medically necessary services that Original Medicare covers,” per Medicare.gov. The differences are in process and cost. You “may need to use doctors and other providers who are in the plan’s network,” and you “may need to get approval (prior authorization) from your plan before it covers certain services or supplies.” Plans also set a yearly limit on what you pay for covered Medicare services. The DME MAC LCDs described on this page govern Original Medicare claims; a plan may apply its own criteria. Ask the plan for its wheelchair policy in writing before ordering.

Replacement and repairs

Under 42 CFR 414.210(f), Medicare pays to replace equipment that “has been in continuous use by the patient for the equipment’s reasonable useful lifetime,” or earlier if “the item is lost, stolen, or irreparably damaged.” The reasonable useful lifetime cannot be less than 5 years, and “computation is based on when the equipment is delivered to the beneficiary, not the age of the equipment.”

Repairs to beneficiary-owned equipment are paid under 414.210(e). A supplier that transferred title to a capped rental item must replace it at no cost if it does not last its full useful lifetime, and the contractor may consider whether accumulated repair costs exceed 60 percent of the replacement cost. LCD L33788 allows a standard manual wheelchair to be rented for one month while a beneficiary-owned chair is being repaired.

What is not covered

• A chair needed only outside the home. Policy Article A52498 states that if a power wheelchair or scooter “is only for use outside the home, it will be denied as noncovered.”
• A second or backup wheelchair. Both LCDs allow payment for only one wheelchair at a time.
• A Group 2 scooter (K0806 to K0808) or a Group 4 power wheelchair. LCD L33789 says these have capabilities not needed in the home and denies them as not reasonable and necessary.
• A device for a reversible condition expected to last less than three months.
• Any claim without the required order, face-to-face documentation or, for power devices, an affirmed prior authorization.

What changed recently

• October 28, 2026: CMS’s required lists comparison chart shows prior authorization required nationwide for K0005, every Group 1 to 3 power wheelchair code and every scooter code, and the face-to-face and written order before delivery requirement for K0002 through K0007 and E1161.
• October 1, 2026: LCD L33788 (Manual Wheelchair Bases) revision R5 took effect. It added code E0150 to the Group 1 HCPCS codes and a reference to NCD 280.1. The DME MACs posted it September 25, 2026.
• April 13, 2026: CMS-6097-N took effect, adding 18 codes to the Master List (including power wheelchair accessory E2377) and 8 oxygen codes to the face-to-face list. No wheelchair base codes were added to the prior authorization list.
• January 1, 2026: The Part B deductible rose to $283. The DMEPOS fee schedule update factor was 2.0% for amounts not adjusted through competitive bidding (CPI-U 2.7% less a 0.7% productivity adjustment), per MLN MM14326.
• October 1, 2025: LCD L33789 (Power Mobility Devices) revision R9 took effect.

Where to check

• Medicare.gov: Wheelchairs & scooters
• Medicare.gov: Durable medical equipment coverage
• Medicare.gov: Medicare costs
• LCD L33788: Manual Wheelchair Bases
• LCD L33789: Power Mobility Devices
• NCD 280.3: Mobility Assistive Equipment
• 42 CFR 414.229 (capped rental) and 42 CFR 414.210 (replacement)

For a specific case, ask the treating practitioner and a Medicare-enrolled supplier. The supplier can confirm whether it accepts assignment and which payment category applies.