Summary
Independence Blue Cross reissued MA05.026d on 05/27/2026 to reaffirm its continuing position on manual wheelchair coverage for New Jersey Medicare Advantage members. The policy removes face-to-face requirements for 14 specific wheelchair codes (E1037, E1161, E1232-E1238, K0002-K0007, K0009) per CMS Final Rule, effective 01/01/2024. Medical necessity criteria remain unchanged: coverage requires all five base criteria plus either self-propulsion ability (criterion 6) or caregiver assistance (criterion 7).
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What to do
Action · 5 steps
01By 06/30/2026: Billing team must verify that manual wheelchair claims for New Jersey Medicare Advantage members no longer require face-to-face documentation for codes E1037, E1161, E1232-E1238, and K0002-K0007, K0009.
02Update prior authorization templates and claim submission workflows to reflect removal of face-to-face requirements.
03Ensure documentation in billing system reflects that medical necessity criteria (all five base criteria plus either criterion 6 or 7) are the only requirements for coverage.
04Audit any claims denied in 2024-2025 for face-to-face documentation requirements on these codes and consider resubmission appeals.
05Providers should update intake forms and documentation checklists to focus on mobility-related activities of daily living (MRADLs), upper-extremity function, caregiver availability, and home accessibility instead of face-to-face visit requirements.
If missed: Failure to update workflows may result in unnecessary claim denials or delayed approvals.
Codes mentioned
E1037E1161E1232E1233E1234E1235E1236E1237E1238K0001K0002K0003K0004K0005K0006K0007K0009
Original notice
MA05.026d, Manual Wheelchairs
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA05.026d, Manual WheelchairsMediumNo effective date · Medical Policy05.00.12j, Manual WheelchairsHighEffective Apr 13, 2023 · Medical Policy05.00.12j, Manual WheelchairsMediumEffective Apr 13, 2023 · Medical PolicyMA05.026f, Manual WheelchairsHighEffective Oct 28, 2026 · Medical PolicyBrowse every Independence Blue Cross change in the policy list
Related policy hubs
Independence Blue Cross policiesNJ policy changesPhysical TherapyOccupational TherapyPM&R (Physical Medicine & Rehab)GeriatricsGeneral PracticeCode E1037Code E1161Code E1232Code E1233Code E1234Code E1235Code E1236Code E1237Code E1238Code K0001Code K0002Code K0003Code K0004Code K0005Code K0006Code K0007Code K0009