CommercialCoverageHigh impact
Wheelchairs and Power Operated Vehicles (POVs) 1.01.16
Excellus BlueCross BlueShield·PM&R (Physical Medicine & Rehab), Physical Therapy, Occupational Therapy +4 more·Durable Medical Equipment & Supplies
Effective date
Aug 21, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their wheelchair and power operated vehicle (POV) policy effective August 21, 2025, establishing specific medical necessity criteria, coverage limitations, and documentation requirements. The policy restricts coverage to medically necessary wheelchairs for activities of daily living in the home, excludes comfort/convenience use, and requires comprehensive evaluations and documentation for approval.
Action Required
By August 21, 2025: Billing team must update wheelchair and DME authorization processes to ensure all wheelchair claims include required documentation: diagnosis/prognosis, seating and mobility evaluation by trained professional, home environment assessment, and medical necessity justification. Providers must document why motorized wheelchairs are needed over manual options. Update encounter forms and EMR templates to capture all required elements. Claims without proper documentation will be denied.