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KMAP BULLETIN: Coverage of Stroller-Type Pediatric Wheelchair Devices

Date: 07/09/26

KMAP GENERAL BULLETIN 26116 (PDF)

Effective with dates of service on and after August 1, 2026, Kansas Medicaid will provide coverage for stroller-type pediatric wheelchair devices when the device has been Pricing, Data Analysis, and Coding (PDAC) verified or has a PDAC-assigned code for the durable medical equipment (DME) product.

Coverage Criteria:
A stroller-type pediatric wheelchair device meets the definition of medical necessity for a non-ambulatory member when one or more of the following criteria are met:

  • The member has a medical condition, and medical necessity cannot be accommodated by other wheelchair devices.
  • The device will serve as the primary mobility device due to inability to self-propel a manual wheelchair or power wheelchair.
  • The device is the most economical alternative available to meet the member’s mobility needs.
  • All stroller-type pediatric wheelchair device requests must include documentation of the growth capabilities of the equipment requested and how the equipment accommodates the member’s growth.

Non-Covered Items

The following items are not covered:

  • Storage baskets
  • Medical supply bags
  • Bag hooks
  • Canopies


Coverage Limitations:

  • Only one wheelchair (manual, power, or stroller-type pediatric wheelchair device) will be purchased or rented within a five-year period.
  • KBH-EPSDT members are excluded from this limitation.
  • Back-up manual, power, or stroller-type pediatric wheelchair devices are considered duplication of service and will not be allowed.

Covered HCPCS Codes:

 E1231  E1235 
 E1232  E1236 
 E1233  E1237 
 E1234  E1238

 

Note: The effective date of the policy is August 1, 2026. 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 8-86, 8-87, and 8-90.