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K0831

PAYER POLICY CHANGES

K0831 Insurance Policy Changes

HCPCS K0831 is officially defined as "Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds." HCPCS K0831 is referenced in 14 tracked payer policy changes from HealthPartners, Medicare/CMS - LCD, and 6 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS K0831 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

HealthPartners · Effective Jan 1, 2027High impact
Fast Facts Newsletter - November 2026
HealthPartners' November 2026 Fast Facts newsletter lists several changes, most effective January 1, 2027: Cigna-insured members will require precertification for outpatient non-emergency CT, MRI and PET imaging; manual and power mobility device codes will require prior authorization for Medicare Advantage, Medicare Cost and MSHO members; Actemra is being replaced by the biosimilar Avtozma and several diabetes and insulin drugs are leaving the formulary; and Minnesota Medicaid moves to MNAAC pharmacy reimbursement. The billing team should also note the standing reminder to submit any change to a previously filed claim as a corrected claim with Bill Frequency Code 7.
Medicare/CMS - LCD · Effective Dec 20, 2026Medium impact
Power Mobility Devices
CMS LCD L33789 (Power Mobility Devices, CGS and Noridian DME MACs) is revised with a source-stated effective date of 12/20/2026, after the 11/06/2026 analysis date, so it is not yet in effect. The revision adds coverage criteria (II.A–II.G) for non-complex Group 2 seat elevator power wheelchairs (K0830, K0831) and renumbers subsequent sections, and it states that claims not meeting these criteria will be denied as not reasonable and necessary.
L.A. Care Health Plan · Effective Oct 28, 2026High impact
Updated HCPCS Codes Requiring Prior Authorization – Medicare
L.A. Care Health Plan now requires prior authorization for eight HCPCS codes for its Medicare members, following CMS's addition of those codes to the DMEPOS Required Prior Authorization List, effective October 28, 2026. Separately, 22 HCPCS codes were added to the Required Face-to-Face Encounter and Written Order Prior to Delivery list effective the same date, requiring a documented face-to-face encounter within six months before the written order and communication of the order to the supplier before delivery.
Independence Blue Cross · Effective Oct 28, 2026High impact
MA05.046l, Wheelchair Options and Accessories
Independence Blue Cross Medicare Advantage added Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization requirements to eight wheelchair and wheelchair accessory HCPCS codes (E1161, K0002, K0003, K0004, K0005, K0006, K0007, K0831) effective 10/28/2026. The practice must obtain prior authorization before delivering these items to IBC MA members.
Independence Blue Cross · Effective Oct 28, 2026High impact
05.00.67w, Wheelchair Options and Accessories
Independence Blue Cross added face-to-face encounter and written order prior authorization requirements to eight wheelchair HCPCS codes (E1161, K0002, K0003, K0004, K0005, K0006, K0007, K0831) effective 10/28/2026, aligning with Medicare Final Rule. The practice must obtain prior authorization before these wheelchairs are delivered or prior to authorization issuance.
BlueCross BlueShield of South Carolina · Effective Aug 1, 2026High impact
Important Update – Prior Authorization for DME & Home Health Services
Beginning August 1, 2026, IHCS supports prior authorizations for Durable Medical Equipment (DME) and Home Health services for BlueCross BlueShield of South Carolina small group and individual plans, including Affordable Care Act (Marketplace) plans. This applies to members with group number prefixes 61, 62, 64 and 65. Providers are encouraged to submit requests for the listed codes to IHCS through WellSky CarePort or CarePort Provider Portals, Availity Essentials, or Parachute Health.
Blue Shield of California · Effective Nov 1, 2026Medium impact
Power Wheelchairs and Power Operated Vehicles for Permanent Use (BSC1.02)
Blue Shield of California policy BSC1.02 sets the medical necessity criteria for power wheelchairs and power operated vehicles for permanent use. A power wheelchair may be considered when the member has a mobility limitation that significantly impairs mobility-related activities of daily living in customary locations, that limitation cannot be resolved with an appropriately fitted cane, crutch or optimally configured manual wheelchair, the member lacks the upper extremity function to self-propel a manual wheelchair, the member can safely operate the device, and the member's weight is within the device's capacity. The 11/01/2026 annual review made no change to the policy statement.
Independence Blue Cross · Effective Oct 28, 2026Medium impact
MA05.032e, Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Power-Assist System Devices
Independence Blue Cross Medicare Advantage added a face-to-face encounter and written order prior authorization requirement for HCPCS code K0831 (Power wheelchair, group 2 standard, seat elevator, captain's chair, patient weight capacity up to and including 300 pounds), effective 10/28/2026. The practice must obtain prior authorization before delivering this device to Medicare Advantage members.
Independence Blue Cross · Effective Oct 28, 2026Medium impact
05.00.54m, Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Power-Assist System Devices
Independence Blue Cross added face-to-face encounter and written order prior to delivery and/or prior authorization requirements to HCPCS code K0831 (Power wheelchair, group 2 standard, seat elevator, captain's chair, patient weight capacity up to and including 300 pounds) effective 10/28/2026, in accordance with Medicare Final Rule. The billing team must obtain prior authorization before delivering this device and ensure documentation of a face-to-face encounter and written order are in place.
HealthPartners · Effective Oct 1, 2026Medium impact
Fast Facts Newsletter - August (Special Edition) 2026
HealthPartners moved management of its chiropractic provider network to Optum Health as of July 1, 2026, so chiropractic claims go directly to HealthPartners rather than Fulcrum, which ceases operations August 31, 2026. Several changes carry 2026 dates: Minnesota SUD services must be billed under the DHS Behavioral Health Fund Billing Grid effective October 1, 2026, power wheelchair prior authorization was expanded to include K0830 and K0831 effective 10/1/2026, and Cohere Health coverage criteria for Commercial, Medicaid and Medicare Advantage plans were revised effective 10/01/2026. Other updates include Actemra being replaced by the biosimilar Avtozma on the formulary, a Part B preference for Avtozma that applies only to new starts, and a revised temporomandibular disorder policy that removed diagnostic imaging from the list of non-surgical services.
Aetna · Identified Oct 6, 2026Medium impact
Wheelchairs and Power Operated Vehicles (Scooters) (CPB 0271, reviewed 2026-08-21)
Power mobility devices, including power operated vehicles (scooters), power wheelchairs and push-rim activated power assist devices, are considered medically necessary only when the member has a mobility limitation that significantly impairs mobility-related activities of daily living in the home and that limitation cannot be sufficiently and safely resolved with an appropriately fitted cane or walker. Power operated vehicles and power wheelchairs are considered not medically necessary when they are needed only for use outside the home, and Group 2 power operated vehicles (K0806 to K0808) are considered not medically necessary because they have added capabilities that are not needed for use in the home. Cup holders, dynamic seating, lighting systems and snow tires are listed as not covered.
Aetna · Identified Aug 19, 2026Medium impact
Wheelchairs and Power Operated Vehicles (Scooters) (CPB 0271, reviewed 2025-12-18)
Aetna's Clinical Policy Bulletin 0271 sets medical necessity rules for manual wheelchairs, power wheelchairs, power operated vehicles (scooters), and their options, accessories and seating. A manual wheelchair for use in the home is considered medically necessary when the member's mobility limitation significantly impairs mobility-related activities of daily living, a properly fitted cane or walker cannot sufficiently resolve it, the member has sufficient upper extremity function, and a caregiver is available, willing and able to assist. Power wheelchairs and scooters must also meet the basic power mobility criteria and the criteria for their specific type, and Group 2 scooters (K0806-K0808) are considered not medically necessary because they have added capabilities that are not needed for use in the home.
Premera Blue Cross · Identified Jun 18, 2026Medium impact
Medical Policy and Coding Updates - July 2020
Effective July 1, 2020, Autologous Chondrocyte Implantation policy 7.01.48 and Electrical Stimulation of the Spine policy 7.01.85 replaced policies 7.01.569 and 7.01.571, and SARS-CoV-2 serology criteria were updated to align with CDC interim guidelines issued May 23, 2020. Effective October 2, 2020, Pharmacologic Treatment of Infertility was added as a new policy covering brand chorionic gonadotropin, Bravelle, Follistim AQ and Pregnyl, and Kyprolis and Velcade were added under Miscellaneous Oncology Drugs. Coding updates made numerous codes subject to medical necessity and prior authorization review, including HCPCS J0791, J0223, E0761, J0896, Q5120, J9358, J1558, J9177, J1429, J3399, Q5119 and Q5121, and removed that review for many codes, including CPT 33981, 33982 and 33983 and the InterQual-reviewed wheelchair and hospital bed codes.
Premera Blue Cross · Identified Jun 18, 2026Medium impact
Medical Policy and Coding Updates - February 2021
This Premera medical policy and coding update lists changes from February 2021. Updated AIM Specialty Health molecular testing criteria took effect May 10, 2021, adding tumor markers such as FoundationOne CDx and revising MRD testing so it must be performed on bone marrow. Other changes include revised advanced imaging criteria effective March 14, 2021, and medical necessity or prior authorization review added or removed for several codes effective February 1 and February 5, 2021.

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REFERENCE DATA

Payers with rules18

Payers requiring prior auth18

Aetna · Effective November 1, 2026
Prior authorization required
Participating provider precertification list for Aetna
Anthem BCBS · Effective November 1, 2026
Prior authorization required
Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)
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)

FREQUENTLY ASKED QUESTIONS

Does Aetna require prior authorization for K0831?

Aetna lists K0831 on Participating provider precertification list for Aetna for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for K0831?

AmeriHealth Caritas lists K0831 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 K0831?

Anthem BCBS lists K0831 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for K0831?

Arizona Complete Health lists K0831 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for K0831?

BCBS Arizona lists K0831 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS K0831?

There are 14 tracked policy changes affecting HCPCS K0831, including updates from HealthPartners, Medicare/CMS - LCD, L.A. Care Health Plan. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS K0831?

Payers that have issued tracked updates for HCPCS K0831 include: HealthPartners, Medicare/CMS - LCD, L.A. Care Health Plan, Independence Blue Cross, BlueCross BlueShield of South Carolina, Blue Shield of California, Aetna, Premera Blue Cross.

How do I get notified when HCPCS K0831 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS K0831. 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 K0831?

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.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Fast Facts Newsletter - November 2026

Power Mobility Devices

Updated HCPCS Codes Requiring Prior Authorization – Medicare

MA05.046l, Wheelchair Options and Accessories

05.00.67w, Wheelchair Options and Accessories

Important Update – Prior Authorization for DME & Home Health Services

Power Wheelchairs and Power Operated Vehicles for Permanent Use (BSC1.02)

MA05.032e, Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Power-Assist System Devices

05.00.54m, Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Power-Assist System Devices

Fast Facts Newsletter - August (Special Edition) 2026

Wheelchairs and Power Operated Vehicles (Scooters) (CPB 0271, reviewed 2026-08-21)

Wheelchairs and Power Operated Vehicles (Scooters) (CPB 0271, reviewed 2025-12-18)

Medical Policy and Coding Updates - July 2020

Medical Policy and Coding Updates - February 2021

Prior authorization required