Part 18 in our series A to Z Considerations for Seating & Wheeled Mobility: A Quick Reference Clarifying Confusion Around CRT. See Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9, Part 10, Part 11, Part 12, Part 13, Part 14, Part 15, Part 16, and Part 17.
While Medicare does not recognize/pay for wheelchairs in the Group 4 category, it is important to at least briefly discuss this grouping as some private insurances, as well as the VA, will occasionally fund these bases. Also, some clients choose to pay the difference—out of pocket or through fundraising—to upgrade to this grouping of chair as it really is what best meets their needs.
So, what is a Group 4 power wheelchair?
Essentially, a Group 4 power wheelchair is the same as a Group 3 power wheelchair but with added capabilities that are not needed in the home. This is why these wheelchairs are denied by Medicare as they are deemed not reasonable or medically necessary. However there are clients who need these features to perform their daily activities. For example, a client who lives in the country and needs to daily navigate rough terrain needs a power wheelchair that climb obstacles and offer dynamic stability on an incline. A Group 4 power wheelchair can offer these features.
There are ways to get the funding for Group 4 power wheelchairs when you determine that it is necessary for your client’s optimal independence and function. Permobil offers a unique option on Group 3 chairs in which the ATP can select the Group 3 to Group 4 upgrade in one line item. This allows the opportunity to streamline the submittal and allow a traditional funding source to deny the group 4 base upgrade only and not the entire chair. This then allows the consumer to pay for the ugrade line cost themselves or allows the dealer to submit that denied portion to a secondary funding with different standards like a vocational rehab funding source or a trust, etc. In many cases this gives the client a path to a better chair while getting the most out of their primary funding source.
Group 4 power wheelchairs typically come standard with a more powerful battery that will last longer distances, as well as support the additional power features offered on this style of base.
Group 4 power wheelchairs offer power standing in addition to power elevate/power adjustable seat height, power tilt, power recline, power elevating leg rests, and power anterior tilt. Group 4 power wheelchairs offer increased power elevate/power adjustable seat height, up to 14”
Although a standing feature is not tied to the Group 4 code, power standing in addition to power elevate/power adjustable seat height are features that are available on a Group 4 base. These are in addition to the options of power tilt, power recline, power elevating leg rests, and power anterior tilt. And Group 4 power wheelchairs offer increased power elevate/power adjustable seat height, up to 14”
Power standing can be truly beneficial and life changing for individuals who are confined to a wheelchair:
- Facilitates pressure relief for healthy skin
- Prevents pressure injuries
- Facilitates improved circulation
- Prevents hip and knee contracture
- Increases bone density
- Improves respiration
- Improves bowel and bladder function
- Improves quality of life
Imagine having a spinal cord injury and not being able to stand beside your spouse on your wedding day? Or, not being able to look your loved ones in the eye? Imagine being told you would NEVER stand again…and then being able to do that via your power wheelchair? Think of not only the PHYSICAL benefits but also the PSYCHOLOGICAL and EMOTIONAL benefits.
Now that you have a clearer understanding of all of the available options for adult power bases, there is one more power chair that we need to discuss: the Group 5, which is pediatric power wheelchair. Join me next week for a brief discussion of pediatric power wheelchair options!
Lindsey Sharpe, PT, DPT
Lindsey Sharpe graduated with a BA in Exercise and Sport Science from the University of North Carolina at Chapel Hill in 2007 and with her Doctor of Physical Therapy from Elon University in 2010. Lindsey was a practicing clinician for seven years primarily focusing on neurological conditions and wheelchair seating and positioning.
Lindsey was first introduced to wheelchair seating and positioning during her time on the spinal cord injury team at the University of Virginia's acute rehab hospital where she discovered her interest in and passion for this niche in the therapy world. Lindsey went on to open a brand-new seating clinic with Carolinas Healthcare System in Concord, NC where she advanced her knowledge and skills performing both inpatient and outpatient seating evaluations for clients of all ages having a variety of diagnoses.