What is Advanced Determination of Medicare Coverage (ADMC)?

What Is ADMC?

Advance Determination of Medicare Coverage allows suppliers and beneficiaries to order supplies in advance so that the prescribed items are available, when needed. Since manual and automatic wheelchairs are deemed as one of the most sought after items therefore ADMC allows beneficiaries to pre-order these. In fact, these are the only items on ADMC list.

Unlike other perishable objects, wheelchair is sophisticated machinery therefore requiring stringent safety checks before it could be distributed to older individuals. This is precisely why such requests may not be entertained because authorities in charge of ADMC program have to evaluate each request, carefully.

Following is a brief list of eligible items:

Manual adult size wheelchair
Manual pediatric size wheelchair
Manual adult size ultra lightweight wheelchair
Manual adult size wheelchair, not otherwise classified
Power adult size wheelchair, Single or Multiple power options
Power adult size wheelchair, No power options
Power pediatric size wheelchair

It is also recommended to check with your insurance provider as they may be able to provide additional options. All requests for Advance Determination of Medicare Coverage should be sent to National Government Services at the following address:

National Government Services, Inc.
Attn: Medical Review—ADMC
P.O. Box 7018
Indianapolis, Indiana 46207-7018

What Is Included?

As of April 2006, Certificates of Medical Necessity are no longer required to file for Advance Determination of Medicare Coverage. Instead, ADMC requests beneficiaries to provide additional details on the request form. Besides, suppliers and beneficiaries can also request special considerations for wheelchair modifications or related accessories. If required, ADMC may ask the patient for a face-to-face examination with a physician.

Usually, a decision is made within 30 days of the initial request. If the decision is negative then request for all accessories become void. On affirmative decision, ADMC reserves the right to review additional accessories, individually.

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