№ lp_1_2_63656
File format: docx Character count: 12541 File size: 41 KB
This document outlines the guidelines for determining the medical necessity of standers and power-assisted standing components for wheelchairs based on clinical data, including patient eligibility and necessary documentation for MassHealth coverage.
Note: Year
Topic: Durable Medical Equipment, Medical Necessity
Document Type: Guidelines
Institution: MassHealth
Target Audience: Healthcare providers, MassHealth providers, Medicaid specialists
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

Don’t have cryptocurrency yet?

You can still complete your purchase in a few minutes:
  1. Buy Crypto in a trusted app (Coinbase, Kraken, Cash App or any similar service).
  2. In the app, tap Send.
  3. Select network, paste our wallet address.
  4. Send the exact amount shown above.
After sending, paste your TXID (transaction ID) and your email to receive the download link. Need help? Contact support and we’ll guide you step by step.

The final amount may vary slightly depending on the payment method.
The file will be sent to the email address provided at checkout within 24 hours.
The product description is provided for reference. Actual content and formatting may differ slightly.
Patient Information Stander Evaluation
Year: 2017
Region / City: Unknown
Theme: Medical Evaluation, Pediatric Care
Document Type: Medical Report
Institution: XXXXXXXXXXXXXXX Hospital
Author: May Smith, PT, ATP, SMS
Target Audience: Medical professionals, caregivers
Period of Action: 2017
Date of Approval: 01/01/2017
Date of Changes: Not specified
Prescription & Prior Authorization Request for Medical Equipment Excluding Wheelchairs & Wheelchair Components
Year: 2023
Region / City: Arkansas, United States
Theme: Medical Equipment, Prior Authorization
Document Type: Form
Institution: Arkansas Foundation for Medical Care, Inc.
Author: Arkansas Foundation for Medical Care, Inc.
Target Audience: Healthcare providers, prescribing physicians, advanced practice registered nurses, Medicaid beneficiaries
Period of Validity: Not specified
Approval Date: Not specified
Date of Changes: Not specified
Specialized Wheelchairs and Wheelchair Seating Systems for Individuals Age Two Through Adult
Year: 2019
Region / State: Arkansas
Topic: Medicaid coverage for wheelchairs
Document Type: Procedure code description
Organization / Agency: Arkansas Medicaid
Target Audience: Healthcare providers
Procedure Code: E0952
Related Procedure Codes: E0951
Prior Authorization Required: Yes
Payment Method: Purchase
Age Range: Two through adult
Limitations: Items exceeding $1,000 require PA
Notes: Certain codes must be billed on paper
PDAC Test Report for Performance Testing of Power Mobility Devices (Wheelchairs and Scooters)
Document Type: Performance test report form
Subject: Performance testing of power mobility devices
Applicable Products: Power wheelchairs (PWC) and power operated vehicles (POV)
Testing Standards: RESNA WC-1:2009; RESNA WC-2:2009
Testing Sections Referenced: Static Stability; Dynamic Stability; Effectiveness of Brakes; Theoretical Range; Dimensions; Maximum Speed; Seating Dimensions; Obstacle-Climbing; Power and Control Systems
Regulatory Reference: PDAC requirements for Sections 1, 2, 3, 4, 5, 6, 10 and 14
Coding System: Healthcare Common Procedure Coding System (HCPCS)
Performance Groups: Group 1–5 for PWC and POV
Testing Institution: Independent test laboratory capable of conducting RESNA testing procedures
Test Data Fields: Manufacturer information; device model and serial/batch number; product and accessory weights; seat width tested; manufacture date
Verification Requirement: Failure of at least one test in a higher performance group for classification in a lower group
Battery Requirements: Sealed non-spillable batteries compliant with DOT CFR 173.159(d) and IATA Packing Instructions 806
Motor Types: 2-pole; 4-pole; other motor types
Seat Styles: Sling seat/back; solid seat/back; captain’s chair
Controller Types: Standard integrated control input device; remote proportional control input device
Testing Components: Test dummy center of mass verification; static stability testing in forward, rearward and lateral directions
Documentation Requirements: Labeled images of test set-ups with date/time stamp, test section and clause number
Report Fields: Test lab name; address; phone number; report preparer; report date; signature of responsible person; testing date range
Topics: Power-Assisted Stander Wheelchairs