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Wheelchairs and Power Operated Vehicles (POVs) 1.01.16
Effective date
Aug 20, 2026
Identified
Jun 20, 2026
Summary
Excellus BlueCross BlueShield policy 1.01.16 covers wheelchairs and power operated vehicles when the member meets the criteria listed for each device type, and treats wheelchairs used primarily for comfort, convenience, or transportation outside the home as not medically necessary. The 12/10/25 code edit replaced K0074, K0075 and K0076 with E2214, E2219 and E2221, and replaced K0066, K0067 and K0068 with E2220, E2221 and E2222. The 08/20/26 annual review states the policy intent is unchanged, and the current effective date is August 20, 2026.
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What to do
Action · 11 steps
01REQUIREMENTS: Coverage of wheelchairs and accessories or special features requires documentation of medical necessity by the individual's practitioner, submitted for review.
02The documentation must include the diagnosis, prognosis and severity of the condition, a seating and mobility evaluation by a trained professional, an assessment of the home environment for wheelchair accessibility, an explanation of why a standard wheelchair is inadequate if a motorized wheelchair is requested, and relevant medical records.
03Coverage is provided for one manual wheelchair, one motorized wheelchair, or one scooter, and a back-up wheelchair is not covered except a one-month rental when the owned wheelchair is being repaired.
04Power operated vehicles require that the member meets wheelchair criteria, is unable to maneuver a manual wheelchair for a distance greater than 25 feet, can safely transfer in and out of the vehicle and has adequate trunk stability, has a non-progressive condition, and has a disability expected to continue for greater than six months.
05Motorized wheelchairs require that the member meets manual wheelchair criteria, is unable to maneuver a manual wheelchair for a distance greater than 25 feet, has an upper extremity impairment and cannot self-propel a manual wheelchair, can safely operate a power wheelchair, and is expected to need it for greater than six weeks.
06Repair of a medically appropriate device not under warranty requires physician documentation of the date of DME initiation, manufacturer warranty information if applicable, and an attestation that the patient has been compliant with the DME and will continue to benefit, and the device must no longer function adequately, interfere with activities of daily living, and be expected to become fully functional on repair.
07Replacement requires that the device is no longer functioning adequately and is non-repairable or the repair cost exceeds the replacement cost, or that a change in the patient's condition makes the unit non-functional with improvement expected from a replacement.
08Replacement of a properly functioning unit is not medically necessary.
09Equipment damaged by patient neglect, theft, or abuse, or when another available coverage source exists, is ineligible for repair or replacement coverage.
10Accessories or components considered not medically necessary or investigational by peer-reviewed literature are considered not medically necessary or investigational by the health plan.
11Services are contract dependent.
Codes mentioned
E1031E1038E1050E1060E1070E1083E1084E1085E1086E1087E1088E1089E1090E1092E1093K0006E1100E1110E1161K0011E1229E1230E1239K0003K0001K0002K0004K0005K0007K0008K0009K0010K0012K0013K0014E0953E0954E0955E0966E0971E1012E1022E1023E1028E1032E1033E1034E1014E2291E2293E2398K0669E0973E0994K0015E0968E0978E0981E0992E1007E2230E2231E2292E2294E2295E2298E0951E0952E0970E0990E0995E1010K0047K0195E1011K0056E2205E0967K0065K0069K0070K0071K0072K0073K0077E2214E2219E2220E2221E2222E0961E0974E2206E0950E0958E0959K0098E0986K0733E0956E0957E0969E1035K0105K0108K0074K0075K0076K0066K0067K0068
Original notice
Wheelchairs and Power Operated Vehicles (POVs) 1.01.16
excellusbcbs.com · Always check the source before changing claims.
Related changes
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Excellus BlueCross BlueShield policiesNY policy changesPM&R (Physical Medicine & Rehab)Physical TherapyCode E1031Code E1038Code E1050Code E1060Code E1070Code E1083Code E1084Code E1085Code E1086Code E1087Code E1088Code E1089Code E1090Code E1092Code E1093Code K0006Code E1100Code E1110Code E1161Code K0011Code E1229Code E1230Code E1239Code K0003Code K0001Code K0002Code K0004Code K0005Code K0007Code K0008Code K0009Code K0010Code K0012Code K0013Code K0014Code E0953Code E0954Code E0955Code E0966Code E0971Code E1012Code E1022Code E1023Code E1028Code E1032Code E1033Code E1034Code E1014Code E2291Code E2293Code E2398Code K0669Code E0973Code E0994Code K0015Code E0968Code E0978Code E0981Code E0992Code E1007Code E2230Code E2231Code E2292Code E2294Code E2295Code E2298Code E0951Code E0952Code E0970Code E0990Code E0995Code E1010Code K0047Code K0195Code E1011Code K0056Code E2205Code E0967Code K0065Code K0069Code K0070Code K0071Code K0072Code K0073Code K0077Code E2214Code E2219Code E2220Code E2221Code E2222Code E0961Code E0974Code E2206Code E0950Code E0958Code E0959Code K0098Code E0986Code K0733Code E0956Code E0957Code E0969Code E1035Code K0105Code K0108Code K0074Code K0075Code K0076Code K0066Code K0067Code K0068