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December 2016 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 : 2.2.15 Mobility Aids : 2.2.15.5 Manual Wheelchairs-Heavy-Duty and Extra Heavy Duty

2.2.15.5
A heavy duty wheelchair is defined as a manual wheelchair that:
An extra heavy duty wheelchair is defined as a manual wheelchair that:
2.2.15.5.1
A heavy-duty wheelchair may be considered for prior authorization for short-term rental or purchase when the client has severe spasticity or all the following criteria are met:
An extra heavy duty wheelchair may be considered for prior authorization for short-term rental or purchase when all the following criteria are met:

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