Kansas Medicaid (KMAP) requires prior authorization for a power wheelchair, and this two-page request carries the case. It asks how long the doctor says the chair will be needed, how far the beneficiary can walk, how a manual wheelchair is used, hours of attendant care, whether the beneficiary can operate power controls independently, and whether the home allows access.
The DME provider completes and signs the request with its provider number and NPI, the HCPCS code, manufacturer and model. The prescriber supplies the signed prescription with medical necessity for any options and the clinical facts behind the answers.
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Power Wheelchair Prior Authorization Request
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The DME provider completes, signs and faxes it to KMAP. The prescriber's part is the signed and dated prescription, including medical necessity for any wheelchair options, plus the clinical information behind answers such as walking distance, length of need and ability to operate power controls independently.
Manufacturer retail pricing including options, or an invoice when renting a used in-stock chair; a signed and dated prescription with medical necessity for options; written verification of school or work hours; and documentation explaining why a manual wheelchair does not meet the beneficiary's needs.
Yes. KMAP publishes a Manual Wheelchair PA Request and a Special Wheelchair Seating Device PA Request alongside this power wheelchair form. The request type should match the equipment ordered, and each form must be completed in its entirety to avoid being returned unprocessed.