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Modifier Tool - Jurisdiction C


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Mobility Aid
Reimbursement Resources

 

Manual Wheelchairs

  • Manual Tilt Wheelchair Cheat Sheet
  • Manual Wheelchair Cheat Sheet
  • Manual Wheelchair Documentation Checklist
  • Physician Order form Heavy Extra-Heavy Manual Wheelchair
  • Physician Order form High Strength Lightweight Manual Wheelchair
  • Physician Order form Standard Lightweight Manual Wheelchair
  • Training Handout - Billing Manual Wheelchairs
  • Training Handout - Billing Wheelchair Accessories
  • Power Mobility

  • POV-Scooter Cheat Sheet
  • Power Wheelchair Cheat Sheet
  • Home Evaluation Form - PMD
  • Physician Documentation Request - PMD also available as a Word Document
  • PMD Documentation Checklist
  • PMD Purchase Option - Sample Letter
  • Training Handout - Billing Power Mobility Devices

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    Domos HME Billing
    Phone: 425.882.2035
    Fax: 888.553.1063
    Email: Domos HME Billing