MedicaidPrior AuthHigh impact
Mobility Assistive Devices (Wheelchairs) - MEDICAID - KENTUCKY (Revised)
Humana·KY · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab) +2 more·Medicaid
Effective date
Jul 22, 2026
We identified it
Jul 21, 2026
Summary
Humana Medicaid Kentucky revised its coverage policy for mobility assistive devices (wheelchairs) effective 07/22/2026. The policy requires prior authorization for all wheelchair requests and establishes specific medical necessity criteria for power wheelchairs, manual wheelchairs, scooters, and accessories. Billing teams must ensure all wheelchair claims include required prior authorization, home assessments for power wheelchairs, and specialty evaluations for complex rehabilitation devices.
Action Required
Before 07/22/2026: (1) Billing team must implement mandatory prior authorization requirement in billing system for all wheelchair and mobility device claims for Kentucky Medicaid members. (2) Update claim submission workflow to require documentation of licensed healthcare provider order before processing. (3) For power wheelchair claims (E1239, K0010, K0011): Verify home assessment/evaluation is completed and submitted with prior authorization request; claims without home assessment documentation will be denied. (4) For complex rehabilitation power wheelchairs (E2298): Require specialty evaluation from licensed/certified professional (PT, OT, etc.) with no financial relationship to supplier; document specific medical necessity for special features. (5) For pediatric wheelchair modifications (E1011): Require specialty evaluation documentation demonstrating medical necessity for unique construction/substantial modification. (6) For wheelchair accessories (E2227 gear reduction, replacement cushion covers, chin supports, shoe holders, side guards): Verify general wheelchair criteria are met first; for E2227, confirm 1+ year self-propelling history and specialty evaluation. (7) Providers and suppliers should be notified of documentation requirements before effective date. Failure to obtain prior authorization will result in claim denials; incomplete documentation will delay processing.