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Mobility Assistive Devices (Wheelchairs) - MEDICAID - SOUTH CAROLINA (Revised)

Humana·SC · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab) +4 more·Medicaid
Effective date
Sep 3, 2025
We identified it
Jun 24, 2026
Days to comply

Summary

Humana has revised its South Carolina Medicaid policy for mobility assistive devices including wheelchairs, power wheelchairs, and accessories. The policy establishes specific coverage criteria, requires home assessments for power wheelchairs, and mandates specialty evaluations by certified professionals for complex rehabilitation equipment.

Action Required

Action needed
Before September 3, 2025: Billing team must update prior authorization requirements for Humana South Carolina Medicaid wheelchair claims. Ensure documentation includes licensed provider orders, home assessments for power wheelchairs, and specialty evaluations by certified professionals with no financial relationship to supplier for complex rehabilitation equipment. Update encounter forms to remind providers of ADL documentation requirements and 6-month long-term use criteria for power wheelchairs.

Affected Billing Codes

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