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PAYER POLICY CHANGES

K0007 Insurance Policy Changes

HCPCS K0007 is officially defined as "Extra heavy duty wheelchair." HCPCS K0007 is referenced in 12 tracked payer policy changes from HealthPartners, L.A. Care Health Plan, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS K0007 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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REFERENCE DATA

Payers with rules17
Payers requiring prior auth17
  • BCBS Michigan · Effective October 13, 2026

    Prior authorization required in some cases

    BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

  • BCBS Illinois · Effective October 1, 2026

    Prior authorization required in some cases

    Blue Cross Community Health Plans (Illinois Medicaid) Prior Authorization Code List

  • BCBS New Mexico · Effective October 1, 2026

    Prior authorization required in some cases

    BCBSNM Turquoise Care (New Mexico Medicaid) Preauthorization Procedure Code List

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for K0007?

Ambetter lists K0007 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for K0007?

AmeriHealth Caritas lists K0007 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans, with conditions. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for K0007?

Anthem BCBS lists K0007 on List of items and services that require prior authorization (Medicaid IN) for medicaid managed plans (list dated February 11, 2026). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for K0007?

BCBS Illinois lists K0007 on Blue Cross Community Health Plans (Illinois Medicaid) Prior Authorization Code List for medicaid managed plans, with conditions (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for K0007?

BCBS Michigan lists K0007 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS K0007?

There are 12 tracked policy changes affecting HCPCS K0007, including updates from HealthPartners, L.A. Care Health Plan, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS K0007?

Payers that have issued tracked updates for HCPCS K0007 include: HealthPartners, L.A. Care Health Plan, Independence Blue Cross, BlueCross BlueShield of South Carolina, Excellus BlueCross BlueShield, Indiana Medicaid (IHCP), Aetna.

How do I get notified when HCPCS K0007 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS K0007. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS K0007?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for K0007

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for K0007 in one place.

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