Medical Policy Updates

Notification of Policy Revisions Effective January 25, 2022 (Posted November 30, 2021)

Medical Policy Revision
Wheelchairs (Manual and Power Operated) "Notification" Under the When Covered section, Item III. Criteria for Specific Types of Power Wheechairs (PWC): item #1. Group 1 PWC - removed item c. as follows; “ The wheelchair is provided by a supplier that employs a RESNA-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the member.” Under the When Not Covered section, added item #4 as follows: “ Items used to support activities of daily living (ADLs) that do not address a mobility limitation such as robotic arms (e.g. KINOVA JACO® assistive arm) are considered not medically necessary. Items used for assistance with ADLs are considered to be self-help or convenience items that are not primarily medical in nature. Custodial or self-help care is not covered.” Table 1 under Policy Guidelines updated with addition of KINOVA JACO assistive robotic arm along with associated indications. Policy noticed 11/30/21 with effective date of 1/25/22. Medical Director review. 11/2021.