KMAP BULLETIN: Updated Guidance for Wheelchairs and Accessories

Date: 08/22/25

Effective with date of service on or after September 1, 2025, the additional coverage guidance for wheelchairs and related accessories will be as follows.

Wheelchair Replacement:

Wheelchair purchases are limited to one (1) every five (5) years when cumulative repair costs of an existing wheelchair exceed 75% of the reimbursement allowance for a comparable new model. This limitation does not apply to KanCare beneficiaries eligible under the EPSDT (KBH) program.

Providers are required to consider the member’s future needs, including modifications and anticipated growth, especially for pediatric populations.
Documentation must reflect the potential for adjustment based on the following age-specific requirements:
- Ages 0–12: Wheelchair must allow for at least 3 inches of growth in both seat width and depth.
- Ages 13–17: Minimum 2 inches of growth in width and depth.
- Ages 18 and older: At least 2 inches in width and 1 inch in depth.

Supporting documentation (e.g., frame modifications or growth kits) must be submitted to verify that the wheelchair meets these growth allowances.

Manual Elevating Leg Rests

Manual elevating leg rests are covered only when documentation supports medical necessity related to edema.

Non-Covered Equipment: Pediatric Transport Strollers

Pediatric transport strollers defined as multi-positional, caregiveroperated transport systems with an integrated seat (e.g., Convaid Cruiser models) are not covered.

Manual Wheelchairs: Categories and Criteria

K0003 - Lightweight Manual Wheelchair:

Eligible for prior authorization when the member:

Cannot self-propel a standard wheelchair in the home environment, and
Can independently use a lightweight wheelchair for mobility-related activities of daily living (MRADLs).

K0004 - High-Strength Lightweight Manual Wheelchair:

Includes all criteria for K0003 and at least one of the following:

Enables members to perform activities that are not possible in a standard or lightweight wheelchair, or
Member requires unique dimensions not available in standard models and use the chair for ≥2 hours per day.

K0005 - Ultra-Lightweight Manual Wheelchair:

Designed for members who:

Meet all K0003 criteria, and
Require an optimally configured wheelchair with advanced adjustability (e.g., adjustable seat angle, caster stem, axle position), and
Either self-propel for a significant portion of the day and in the community, or
Have complex medical needs requiring specialized seating or
Cannot self-propel and require custom seating due to conditions such as spasticity, contractures, or postural deformities.

Manual Tilt-in-Space Wheelchairs

Applicable codes: E1161, E1231, E1232, E1233, and E1234

Tilt-in-space manual wheelchairs are covered when:

The member qualifies for a manual wheelchair,
A specialized seating assessment supports the request, and
The member has significant clinical conditions (e.g., quadriplegia, severe spasticity, or hemodynamic instability) that justify the need for pressure redistribution via frame tilt of at least 45 degrees.

Power Seating Systems (Tilt, Recline, or Combination)

Applicable codes: E1002, E1003, E1004, E1005, E1006, E1007, and E1008

Power seating components are covered if:

The member qualifies for a power wheelchair,
A specialized wheelchair seating assessment is completed, and
One of the following criteria is met:
- Tilt-only: For members at high risk of pressure ulcers who cannot perform weight shifts
- Recline-only: For members requiring assistance with bladder management (e.g., intermittent catheterization)
- Tilt and Recline Combination: For members who require management of tone, spasticity, or similar clinical needs

Note: Equipment must be the most appropriate and cost-effective option to meet the member’s clinical and functional needs. Requests not meeting these criteria will be denied as not reasonable and necessary.

Reimbursement Clarification

As per Kansas Administrative Regulation (KAR) 30-5-108a, reimbursement for repairs or used equipment shall not exceed 75% of the reimbursement amount for new equipment.

For detailed guidance, including documentation requirements and billing instructions, please refer to Section 8410 of the Durable Medical Equipment Fee-for-Service Provider Manual.

Note: The effective date of the policy is September 1, 2025. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.

For changes resulting from this bulletin, view the updated DME Fee-for-Service Provider Manual, pages.8-80 to 8-83, 8-85, and 8-87.