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MedicaidCoverageMedium impact

Mobility Assistive Devices (Wheelchairs) - MEDICAID - VIRGINIA (Revised)

Humana·VA · PM&R (Physical Medicine & Rehab), Physical Therapy, Occupational Therapy +2 more·Medicaid
Effective date
Dec 3, 2025
We identified it
Jun 24, 2026
Days to comply

Summary

Virginia Medicaid updated coverage criteria for wheelchairs and mobility devices, establishing specific requirements for power wheelchairs, complex rehabilitation chairs, and wheelchair accessories. The policy includes detailed medical necessity criteria and requires specialty evaluations for complex equipment.

Action Required

Action needed
Before December 3, 2025: Update prior authorization requirements for wheelchair claims to include home assessments for power wheelchairs and specialty evaluations by licensed professionals for complex rehabilitation equipment. Ensure documentation includes specific medical necessity criteria for each wheelchair type and accessory. Review current wheelchair billing procedures to align with new coverage limitations.

Affected Billing Codes

E1239
K0010
K0011
E2298
E2300
E1011
97542
E2209
E2359
E2361
E2363
E2365
E2371
K0733
E2310
E2311
E0954