CSHCN Services Program 2010 > Durable Medical Equipment (DME) > Benefits, Limitations, and Authorization Requirements

17.3.1.1 Authorization Requirements

Adaptive strollers may be authorized only when medically necessary and when all of the following conditions are met:

•The stroller has a firm back and seat, or insert

•A stroller (rather than a wheelchair) is specifically recommended by the licensed therapist completing the wheelchair evaluation

•The requested stroller meets all recommendations made in the wheelchair evaluation

•The client is not expected to develop motor skills necessary for self-propulsion and is not expected to need a travel chair or wheelchair within 2 years of the request date, or the client is expected to be ambulatory within 1 year of the request date

Authorization requests for clients older than 2 years of age must meet the above criteria, and there must be medical documentation of the need for a stroller versus a wheelchair. Medical documentation should indicate that a stroller allows adequate support for a client's particular condition, stature, and need for positioning (completion of the CSHCN Services Program Wheelchair Seating Evaluation Form serves as medical documentation).

The following criteria must be met for the level of stroller requested:

•Level 1: Basic stroller. The client meets the criteria for a stroller

•Level 2: Stroller with tray for oxygen and/or ventilator. The client meets the criteria for a Level 1 stroller and is oxygen- or ventilator-dependent

•Level 3: Stroller with positioning inserts. The client meets the criteria for a Level 1 or Level 2 stroller and requires additional positioning support

Providers should use the following procedure codes and modifiers to submit claims for strollers. Levels 2 and 3 require the addition of a modifier: