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MA05.026d, Manual Wheelchairs
Effective date
Not stated in the notice
Identified
Jun 19, 2026
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 maintains existing medical necessity criteria (7 requirements) and includes a significant April 2023 change that removed face-to-face visit requirements from 13 specific wheelchair and transport chair HCPCS codes per CMS Final Rule. Billing teams should verify current documentation requirements no longer mandate in-person evaluation for these codes.
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What to do
Action · 5 steps
01Billing and clinical documentation teams should confirm that prior authorization submissions for the 16 affected wheelchair codes (E1037, E1161, E1232–E1238, K0002–K0007, K0009) no longer require face-to-face encounter documentation, per the April 2023 CMS Final Rule update.
02Review internal templates and prior authorization workflows to remove any mandatory face-to-face visit requirements for these codes.
03Ensure providers understand that medical necessity can be established through other documentation methods (e.g., telehealth, records review, therapist assessment) as permitted by Medicare.
04Update billing system rules and prior authorization checklists accordingly.
05Note: The 05/27/2026 reissuance appears to be a routine confirmation with no new substantive changes—verify with Independence Blue Cross if implementation of the 2023 face-to-face removal has already been completed.
Codes mentioned
E1037E1161E1232E1233E1234E1235E1236E1237E1238K0002K0003K0004K0005K0006K0007K0009
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 WheelchairsMediumEffective Jan 1, 2024 · 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