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Product Name	Covered/ Denied	Explanation
WALKER	C	if the patient's condition impairs the patient's ability to walk. In conjunction with a wheelchair A walker can be covered in conjunction with a wheelchair, if documented that the walker is required for in-home physical therapy. Heavy Duty Walker (4 wheeled with seat and braking system) if the above conditions are met and the patient weighs in excess of 300 lb..
WATER PRESSURE PAD AND MATTRESS		see PRESSURE REDUCING MATTRESS.
WHEELCHAIR	C	Manual Wheelchairs are covered if the patient would be confined to bed or chair without the use of a wheelchair. Hemi Wheelchairsare covered if the patient is confined to bed or chair, and medical documentation establishes that the patient is unable to use a standard wheelchair because the patient: requires a lower seat height because of short stature or to enable the patient to place his feet on the ground for propulsion Lightweight Wheelchairsare covered when a patient cannot propel himself or herself in a standard wheelchair, and the patient is actually able to propel a lightweight chair. High Strength Lightweight Wheelchairsare covered when the patient self propels the wheelchair while engaging in frequent activities that cannot be performed in a standard or lightweight wheelchair; and/or the patient requires a seat width, depth, or height that cannot be accommodated in a standard, lightweight or hemi-wheelchairand spends at least two hours per day in the wheelchair. Heavy Duty Wheelchairs are covered for patients weighing more that 250 lbs. or having sever spasticity. Extra Heavy Duty Wheelchairs are covered for patients weighing more than 300 lbs. Power Wheelchairs are covered when the following criteria is met: patients condition is such that without the use of a wheelchair he/she would otherwise be bed or chair confined, and patients condition is such that a wheelchair is medically necessary and the patient is unable to operate the wheelchair manually, and patient is capable of safely operating the controls for the power wheelchair. Elevating Leg Rests if used in conjunction with a covered wheelchair and the patient has a musculoskeletal condition or the presence of a cast, or brace, which prevents 90 degree flection at the knee; or the patient has significant edema of the lower extremities that requires having an elevating leg rest. Wheelchair with a Walker, Cane or Quad Cane A walker, cane or quad cane can be covered in conjunction with a wheelchair, if documented that the walker, cane or quad cane is required for in-home physical therapy.
WHEELCHAIR GEL CUSHION	C	if used in conjunction with a covered wheelchair.
WHIRLPOOL PUMP	D	personal comfort item; not primarily medical in nature.
WHITE CANE	D	does not contribute to the treatment of an illness or injury.
WOUND CARE SUPPLIES		see SURGICAL DRESSINGS.

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