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Wheelchairs and Power Operated Vehicles (Scooters) (CPB 0271, reviewed 2025-12-18)
Effective date
Not stated in the notice
Identified
Aug 19, 2026
Summary
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.
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What to do
Action · 13 steps
01Billing team: Before submitting a claim for any item in this policy, confirm a completed Standard Written Order was communicated to the supplier before the claim is submitted.
02The order must include the member's name or identification number, the order date, a general description of the item, each concurrently ordered option or accessory listed separately, the HCPCS code and quantity for each item, the treating practitioner's name and National Provider Identifier, and the practitioner's signature.
03Claims for items billed without a completed SWO will be denied as not medically necessary.
04For power wheelchairs, the face-to-face or telehealth encounter must occur within 6 months before the written order, and the same treating practitioner who completes the examination must write or sign the order (MD, DO, NP or PA).
05The medical record must support the device, including the diagnosis, the progression and severity of the condition, the prior mobility aids tried and why they are insufficient, the mobility limitations in the home, and objective physical exam findings.
06Supplier-prepared statements and physician attestations alone do not provide sufficient documentation.
07For ultralightweight manual wheelchairs, tilt-in-space manual wheelchairs, Group 2 single or multiple power option power wheelchairs, any Group 3 power wheelchair, and power add-on devices, a specialty evaluation by a licensed or certified medical professional such as a PT or OT is required.
08For the first four of those device types, the supplier must employ a RESNA-certified Assistive Technology Professional who performs a home assessment and provides written documentation that the home is accessible for the wheelchair.
09Proof of delivery documentation must be kept on file and made available to Aetna upon request, and services without appropriate proof of delivery will be denied as not medically necessary.
10A new prescription from the treating practitioner is required each time a new device or repair is requested.
11For repairs, submit the age, manufacture and model, date and purchaser of the wheelchair, the cost of repairs versus replacement, and each part or accessory with its HCPCS code and description, and include labor time with K0739.
12For modifications or added accessories, obtain pre-authorization and submit medical necessity documentation for each item.
13Miscellaneous or NOC-coded items must include the item description, manufacturer name, product name and number, supplier price list amount, and the related HCPCS code if applicable, or they will be rejected and must be resubmitted.
Codes mentioned
97542K0800K0806K0807K0808K0003K0004K0005K0006K0007K0008K0013E1161E0983E0986E1002E1003E1004E1005E1006E1007E1008E1009E1010E1012E1034E2298K0830K0831K0835E2609E2617E1229E1235E1031E1037E1038E1039E0958E0953E0956K0108K0739
Original notice
Wheelchairs and Power Operated Vehicles (Scooters) (CPB 0271, reviewed 2025-12-18)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Wheelchairs and Power Operated Vehicles (Scooters) (CPB 0271, reviewed 2026-08-21)MediumNo effective date · DMETherapeutic Chairs (CPB 0434, reviewed 2026-08-03)MediumNo effective date · Medical PolicyAmbulatory Assist Devices: Canes, Crutches, and Walkers (CPB 0505, reviewed 2026-08-03)MediumNo effective date · Medical PolicySeat Lifts and Patient Lifts (CPB 0459, reviewed 2026-07-16)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list
Related policy hubs
Aetna policiesPM&R (Physical Medicine & Rehab)Physical TherapyOccupational TherapyCode 97542Code K0800Code K0806Code K0807Code K0808Code K0003Code K0004Code K0005Code K0006Code K0007Code K0008Code K0013Code E1161Code E0983Code E0986Code E1002Code E1003Code E1004Code E1005Code E1006Code E1007Code E1008Code E1009Code E1010Code E1012Code E1034Code E2298Code K0830Code K0831Code K0835Code E2609Code E2617Code E1229Code E1235Code E1031Code E1037Code E1038Code E1039Code E0958Code E0953Code E0956Code K0108Code K0739