A knee scooter (also called a knee walker or rollabout) is a mobility device designed as an alternative to crutches for individuals who must keep weight off a lower leg or foot, often due to an injury or post-operative recovery. The user rests the injured leg on a padded platform and propels themselves with the uninjured leg. While knee scooters function as medical aids, Medicare coverage rules for this mobility equipment are detailed and depend heavily on specific patient circumstances.
Classification and General Coverage Status
Medicare classifies mobility devices like knee scooters as Durable Medical Equipment (DME). DME is reusable medical equipment prescribed by a physician for use in the home. To qualify as DME, the equipment must be durable, used for a medical reason, not generally useful to someone not ill or injured, and expected to last at least three years.
Knee scooters fit the general description of DME, but coverage is complex because they are often considered a “crutch substitute.” Medicare generally pays for the least restrictive device that meets the patient’s mobility needs. For Original Medicare (Part B) to cover the item, it must be medically necessary for use within the home. While power-operated scooters are explicitly covered, coverage for manual knee scooters can vary, as some local coverage determinations may not include them.
Establishing Medical Necessity for Coverage
Coverage for any mobility device requires proving medical necessity through detailed documentation from a treating physician. The physician must certify that the patient has a health condition that significantly impairs their ability to move around their home. This certification follows a face-to-face examination assessing the patient’s mobility limitations.
The patient must demonstrate they are unable to safely use a cane, walker, or crutches, even with assistance, to perform activities of daily living (ADLs) like bathing or using the bathroom. Documentation must state that the scooter serves a medical purpose, not merely convenience, and that the patient can safely operate the device within their home. If a less restrictive device, such as a walker or manual wheelchair, can sufficiently resolve the mobility limitation, the knee scooter may not meet the necessity criteria for coverage.
Understanding Medicare Part B and Part C Differences
The financial structure for covering DME differs between Original Medicare (Part B) and Medicare Advantage (Part C) plans. Under Original Medicare, Part B generally covers 80% of the Medicare-approved amount for DME after the annual deductible is met. The beneficiary is responsible for the remaining 20% coinsurance. This cost-sharing applies only if the equipment is obtained from a Medicare-enrolled supplier who accepts “assignment.”
Medicare Advantage plans (Part C) must cover at least the same services as Original Medicare, including medically necessary DME. However, the out-of-pocket costs, such as copayments and coinsurance, and the process for obtaining equipment vary significantly by plan. Part C plans often require beneficiaries to use in-network suppliers and may have specific prior authorization requirements. Coverage for DME is often structured as a rental agreement, where Medicare pays a monthly fee for a set period, after which ownership transfers to the beneficiary.
The Practical Steps to Acquiring a Scooter
Once a physician determines a knee scooter is the appropriate mobility aid, the first step is obtaining a detailed written order or prescription. This order must specify the medical necessity and confirm the patient’s ability to use the equipment within the home. The patient should then locate a Durable Medical Equipment supplier enrolled with Medicare.
Confirm that the supplier accepts Medicare assignment to ensure the lowest out-of-pocket cost. For complex DME, the supplier may need to submit a request for “prior authorization” to Medicare before providing the device. The supplier is responsible for gathering and submitting all necessary documentation, including the physician’s notes, to streamline the approval process. If a claim is denied, the beneficiary has the right to appeal the decision.