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Blue Shield of CaliforniaAll Plans · Coverage · Medical Policy · CA · PM&R (Physical Medicine & Rehab), Physical Therapy, Occupational TherapyMedium impact

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

Effective date
Nov 1, 2026
Identified
Sep 1, 2025

Summary

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.

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What to do

Action · 6 steps
01Already effective November 1, 2026: Billing team: for every power wheelchair or power operated vehicle request, keep on file the written prescription stating an anticipated need of 6 months or greater, the provider's face-to-face mobility examination and report, and a detailed product description with manufacturer, make and model.
02For Group 3 power wheelchair requests, also keep a diagnosis of a neurological condition, myopathy or congenital skeletal deformity, a specialty evaluation by a licensed or certified PT, OT or provider who has no financial relationship with the DME supplier, and confirmation that the supplier employs a RESNA-certified Assistive Technology Professional who was directly involved in the wheelchair selection.
03The DME supplier must submit a detailed product description listing the wheelchair base and every option and accessory billed, with the HCPCS code, narrative description, manufacturer and model name or number, and supplier charge for each.
04Miscellaneous options or parts without a specific HCPCS code are coded as K0108, and when more than one K0108 line is billed, the additional information must match the correct line.
05Stop scheduling or billing the items the policy lists as not medically necessary, including Group 2 POV codes K0806, K0807 and K0808, Group 2 PWC codes K0830 and K0831, Group 4 PWC codes, and the listed accessories and options.
06Power seat elevation (E2298) and power standing (E2301) are not covered.

Codes mentioned

E1239K0010K0011K0012K0014K0813K0814K0815K0816K0820K0821K0822K0823K0824K0825K0826K0827K0828K0829K0835K0836K0837K0838K0839K0840K0841K0842K0843K0848K0849K0850K0851K0852K0853K0854K0855K0856K0857K0858K0859K0860K0861K0862K0863K0864K0890K0891E2311E1002E1003E1004E1005E1006E1007E1008E1009E1010E1230K0800K0801K0802K0462K0806K0807K0808K0830K0831K0868K0869K0870K0871K0877K0878K0879K0880K0884K0885K0886E2331E2367K0053E2351E2358E2360E2362E2364E2372E2610E2298E2301E2366E2397K0108

Original notice

Power Wheelchairs and Power Operated Vehicles for Permanent Use (BSC1.02)
blueshieldca.com · Always check the source before changing claims.
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Related policy hubs

Blue Shield of California policiesCA policy changesPM&R (Physical Medicine & Rehab)Physical TherapyOccupational TherapyCode E1239Code K0010Code K0011Code K0012Code K0014Code K0813Code K0814Code K0815Code K0816Code K0820Code K0821Code K0822Code K0823Code K0824Code K0825Code K0826Code K0827Code K0828Code K0829Code K0835Code K0836Code K0837Code K0838Code K0839Code K0840Code K0841Code K0842Code K0843Code K0848Code K0849Code K0850Code K0851Code K0852Code K0853Code K0854Code K0855Code K0856Code K0857Code K0858Code K0859Code K0860Code K0861Code K0862Code K0863Code K0864Code K0890Code K0891Code E2311Code E1002Code E1003Code E1004Code E1005Code E1006Code E1007Code E1008Code E1009Code E1010Code E1230Code K0800Code K0801Code K0802Code K0462Code K0806Code K0807Code K0808Code K0830Code K0831Code K0868Code K0869Code K0870Code K0871Code K0877Code K0878Code K0879Code K0880Code K0884Code K0885Code K0886Code E2331Code E2367Code K0053Code E2351Code E2358Code E2360Code E2362Code E2364Code E2372Code E2610Code E2298Code E2301Code E2366Code E2397Code K0108

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