PhysicalTherapy.com Phone: 866-782-6258


Letter of Medical Necessity-Wheelchair

Kristen Cezat, PT, DPT, NCS, ATP/SMS

September 23, 2020

Share:

Question

What needs to be included in a letter of medical necessity for a wheelchair? 

Answer

We need to document the evaluation of the client's systems including both neurologic and orthopedic, their postural assessment, and their level of function. We can't assume that our funding source is going to approve something just because the client has tetraplegia or paraplegia. We have to state the obvious.

  • State that your client can't stand or ambulate with any assistive device.
  • State that your client is unable to use a lesser cost manual chair because
  • The client can't propel a manual wheelchair, because...
  • if you're are advocating a power wheelchair, document why the client is unable to use a scooter because...

Those things have to be stated clearly for the funding source or you're going to get a denial just based on that.  I like to include that my client is willing to use the recommended complex rehab technology that I have recommended and they can do so safely. That's very important to funding sources.

We need to do a detailed justification of how the spinal cord injury affects the client and how the recommended complex rehab technology will assist with

  • Functional activities of daily living 
  • Mobility
  • Positioning/posture
  • Management of their secondary effects of their spinal cord injury such as orthopedic hypotension, autonomic dysreflexia, intermittent catheterization, etc. 

We need to have a clinical and medical justification for every aspect of the chair that we are recommending.

In addition to the letter of medical necessity, we're also going to need a few things that change over time. So you want to make sure you're up-to-date with the CMS guidelines and your local and national coverage determination of mobility assistive equipment.  We need a statement of concurrence with the physician of the prescribing equipment that you have recommended as well as his or her signature.  A statement of financial independence of the PT or OT from the vendor, there is needed.  There also needs to be a face-to-face evaluation from the physician and a prescription from the physician. Additional documentation will be required if prescribing a power wheelchair.  You can write the best letter in the world, but if you don't have all those things in place, then the chair itself can be denied.  


kristen cezat

Kristen Cezat, PT, DPT, NCS, ATP/SMS

Kristen Cezat is a Board-Certified Specialist in Neurologic Physical Therapy, a RESNA certified Assistive Technology Professional as well as Seating and Mobility Specialist.  She currently works as a clinical specialist at Orlando Health ORMC Institute for Advanced Rehabilitation inpatient rehabilitation where her specialties include direct patient care and program development for patients with SCI and other traumatic and neurologic diagnoses.  She received her Doctor of Physical Therapy degree from the University of Central Florida in 2011.  Presentation experience includes PVA funded conference at Orlando Health titled “Spinal Cord Injury Treatment across the Continuum” in 2017 on topics including Seating and Mobility as well as Basic Transfer/Basic Bed mobility techniques and FPTA Spring Conference in 2019 on topic- “My Patient has a Spinal cord injury, what should I do?” She guest lectures annually with the University of Central Florida’s physical therapy program and is clinical faculty for the UCF-Orlando Health Neurologic Physical Therapy Residency Program.  She works with a team at Orlando Health who have obtained grants from the Paralyzed Veterans of America and the Craig Neilson foundation to serve those living with spinal cord injury in the Central Florida community.  She recently received the APTA’s Spinal Cord Injury Special Interest Group Award for Clinical Excellence in Spinal Cord Injury Care or Service in 2020


Related Courses

Outcome Measures in Spinal Cord Injury
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Live WebinarWed, Dec 9, 2020 at 2:00 pm EST
Wed, Dec 9, 2020 at 2:00 pm EST

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #3869Level: Introductory2 Hours
This course will review outcome measures commonly used in everyday clinical practice for clients with spinal cord injury and their importance in functional goals. Outcome measures discussed will include the ASIA Impairment Scale, 10 Meter Walk Test, 6 Minute Walk Test, Timed Up and Go, Walking Index for Spinal Cord Injury II, and Berg Balance Scale. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Rehab Considerations for the Client with Incomplete Spinal Cord Injury
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #3702Level: Introductory2 Hours
  'Instructor was clear in providing much valuable information - covering information that I had not previously known or just needed to review'   Read Reviews
This course will provide a basic comprehensive overview of the management of clients with incomplete SCI. This will include background information on incomplete SCI and acute medical concerns, evidence-based treatment strategies, gait training, wheelchair selection, and outcome measure selection to provide the clinician with basic knowledge/skills that are applicable to clinical practice. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Wheelchair Selection and Training Considerations for the Client with Spinal Cord Injury
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #3767Level: Intermediate2 Hours
  'Outstanding instructor - extremely knowledgeable and enthusiastic - so much information presented in a clear, organized, and interesting fashion'   Read Reviews
This course will introduce seating/positioning needs common to the client with spinal cord injury, wheelchair selection related to client’s level of spinal cord injury, and training strategies to meet client’s independent mobility goals. Brief discussion of documentation requirements to obtain complex rehab technology for the client with spinal cord injury as well as outcome measures to assess effectiveness of training and intervention selection related to wheelchair training will be performed. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Transfer Training in Spinal Cord Injury
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Live WebinarWed, Nov 11, 2020 at 2:00 pm EST
Wed, Nov 11, 2020 at 2:00 pm EST

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #3817Level: Introductory2 Hours
This course will review functional expectations for common transfer techniques transfers based on the level of spinal cord injury. We will review the sit pivot technique and current research applied to transfer mechanics and upper extremity preservation. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Dynamic Seating
Presented by Michelle Lange, OTR, ABDA, ATP/SMS
Recorded Webinar

Presenter

Michelle Lange, OTR, ABDA, ATP/SMS
Course: #3093Level: Intermediate1 Hour
  'The course provided good problem resolution for patients with different needs than just a standard chair'   Read Reviews
Dynamic seating has four primary functions – to allow movement, to diffuse force, to protect the client, and to protect the seating system and mounting hardware. This course will take a look at the product options, discuss clinical indicators and contra-indicators for dynamic components and present case studies to illustrate these points.