(CMS-10116) Medicare Program: Conditions of Payment of Power Mobility Devices, Including Power Wheelchairs and Power-Operated Vehicles

This collection requires physicians or treating practitioners to provide a written prescription and supporting documentation, including pertinent parts of the beneficiary's medical record to suppliers. This collection also requires the supplier to maintain the prescription and the supporting documentation provided by the physician or treating practitioners and makes them available to CMS and its agents upon request.

The latest form for (CMS-10116) Medicare Program: Conditions of Payment of Power Mobility Devices, Including Power Wheelchairs and Power-Operated Vehicles expires 2027-12-31 and is listed under ICR 202410-0938-003.