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PAYER POLICY CHANGES

K0738 Insurance Policy Changes

HCPCS K0738 is officially defined as "Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing." HCPCS K0738 is referenced in 12 tracked payer policy changes from L.A. Care Health Plan, Independence Blue Cross, and 8 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS K0738 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 rules6
Payers requiring prior auth6
  • 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)

  • Florida Blue · Effective March 27, 2026

    Prior authorization required

    Prior Authorization List: HMO – Marketplace Qualified Health Plans

  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does AmeriHealth Caritas require prior authorization for K0738?

AmeriHealth Caritas lists K0738 on AmeriHealth Caritas Louisiana Act 233 prior authorization service list for medicaid managed plans, with conditions. Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for K0738?

BCBS Michigan lists K0738 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.

Does CalViva Health require prior authorization for K0738?

CalViva Health lists K0738 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Carolina Complete Health require prior authorization for K0738?

Carolina Complete Health lists K0738 on Carolina Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for K0738?

Community Health Plan of Imperial Valley lists K0738 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS K0738?

There are 12 tracked policy changes affecting HCPCS K0738, including updates from L.A. Care Health Plan, Independence Blue Cross, BlueCross BlueShield of South Carolina. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS K0738?

Payers that have issued tracked updates for HCPCS K0738 include: L.A. Care Health Plan, Independence Blue Cross, BlueCross BlueShield of South Carolina, Health Net, Blue Cross of Idaho, WellCare, Indiana Medicaid (IHCP), Aetna, Blue Cross & Blue Shield of Mississippi, Premera Blue Cross.

How do I get notified when HCPCS K0738 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS K0738. 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 K0738?

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 K0738

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for K0738 in one place.

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