Numotion / Medical Necessity

What to expect

Understanding Medical Necessity for Mobility Equipment

Medical necessity is a key requirement for insurance to cover mobility equipment.

Here’s How the Medical Necessity Process Works:

Insurance providers will only approve equipment that is considered medically necessary based on your specific health needs and daily functional limitations. Our team works closely with your healthcare provider to ensure all documentation supports this requirement.

1. Clinical Evaluation

A qualified clinician, such as your physician or therapist, conducts an evaluation to determine:

  • Your current physical abilities and limitations
  • Whether standard equipment meets your needs
  • If more advanced or customized equipment is required to support mobility and independence

Note: For Complex power and manual wheelchairs Step 1 will be a Face-to-Face appointment with the Doctor.

  • Doctor states the need for the requested equipment
  • Doctor will conduct a mobility examination

This evaluation is a crucial step to justify the need for specific equipment.

2. Documentation of Medical Need

The clinician must clearly outline in writing why the mobility device is medically necessary. This documentation typically includes:

  • A detailed Letter of Medical Necessity (LMN)
  • Relevant clinical notes
  • A prescription or order for the recommended equipment

The documentation must demonstrate that the device is essential for performing mobility related activities inside your home and is not primarily for convenience or outdoor use (a common insurance requirement).

3. Equipment Justification

If the recommended equipment includes specialized features or customizations (e.g., power tilt, recline, or alternate controls), each component must be justified individually in the documentation:

We work with your clinical team to ensure:

  • No alternative, less costly device would meet the same need effectively
  • Each feature is tied to a specific medical need
4. Insurance Review

Once all documentation is collected and submitted:

  • Your insurance provider reviews the records to determine if the equipment meets coverage guidelines
  • They assess whether your condition and medical documentation match their definitions of medical necessity

If approved, the equipment moves into the purchasing and delivery process. If denied, we’ll work with your provider to obtain additional documentation and resubmit it as needed.

Tips to Support Medical Necessity Approval

  • Attend all scheduled evaluations and bring any past medical records that may be helpful
  • Be open and specific when discussing your daily mobility challenges with your clinician
  • Make sure your provider understands the exact environment and conditions where you’ll be using the equipment
  • Respond promptly to any follow-up questions or requests for additional information

If you have questions about whether your equipment qualifies as medically necessary, your ATP and clinician will partner to help guide you through the process.