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2012 Texas Medicaid Provider Procedures Manual

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook : 2. Texas Medicaid (Title XIX) Home Health Services : 2.2 Services, Benefits, Limitations and Prior Authorization : 2.2.14 Mobility Aids : 2.2.14.3 Manual Wheelchairs-Standard, Standard Hemi, and Standard Reclining

2.2.14.3
A standard manual wheelchair is defined as a manual wheelchair that:
A standard hemi (low seat) wheelchair is defined as a manual wheelchair that:
A standard reclining wheelchair is defined as a manual wheelchair that:
Has the ability to allow the back of the wheelchair to move independently of the seat to provide a change in orientation by opening the seat-to-back angle and, in combination with leg rests, open the knee angle.
2.2.14.3.1 Prior Authorization
A standard manual wheelchair may be considered for prior authorization for short-term rental or purchase when all the following criteria are met:
A standard hemi wheelchair may be considered for prior authorization for short-term rental or purchase when the client meets criteria for a standard manual wheelchair and the following criteria is met:
A standard reclining wheelchair may be considered for prior authorization for short-term rental or purchase when the client meets criteria for a standard manual wheelchair and one or more of the following criteria are met:

Texas Medicaid & Healthcare Partnership
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