MedicaidCoverageMedium impact
Custom Power Wheelchairs
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy, Neurology +2 more·Provider Notice
Effective date
Mar 16, 2004
We identified it
Jun 21, 2026
Summary
Illinois Medicaid is reiterating its policy on custom power wheelchair coverage, emphasizing that only wheelchairs customized for specific medical conditions qualify for Medicaid reimbursement, while standard wheelchairs remain the responsibility of long-term care facilities. Only enrolled DME providers can submit prior approval requests with required documentation including therapy evaluations and physician certification.
Action Required
DME providers billing Illinois Medicaid: Ensure prior approval requests for custom power wheelchairs include physical/occupational therapy evaluation documenting physical limitations, medical history, current status, documentation of less expensive alternatives considered, and physician certification of medical necessity for each component. Update billing workflows to verify medical necessity documentation for conditions like Muscular Dystrophy, Multiple Sclerosis, severe osteoarthritis, quadriplegia, and severe obesity with pulmonary problems.