CurrentHighmark Blueshield NenyPolicy N/A

Medicare Advantage capped rental items (HCPCS) mapping and purchase rules

Lists HCPCS code pairings and specifies when items that are normally rented may instead be purchased under Medicare Advantage; applies to claims and billing for Highmark Blueshield Neny members. Affected parties include billing staff, providers, and claims processors.

Policy Summary

PayerHighmark Blueshield Neny

PolicyMedicare Advantage capped rental items (HCPCS) mapping and purchase rules

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit purchased class 2 or class 3 power wheelchairs and their accessories on the same claim to avoid unnecessary denials.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6document chunks

manyHCPCS code mappings listed

1billing guidance sentences

Coverage mappings and billing instructions

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

HCPCS capped rental-to-purchase mappings: If the listed capped rental HCPCS code maps to a purchase HCPCS code or lists 'Items that can = [code]', then the mapped item is eligible for purchase instead of rental as shown in the mapping list (see mapping table).

Examples of mappings include (excerpt): A7025, E0302 = E0303; E0117, Items that can = K0835; E0170, Items that can = K0840; E0194, Items that can = K0851; E0250, Items that can = K0858; E0295, Items that can = . (Refer to full mapping list in policy for complete pairings).

Billing instruction: When a class 2 or class 3 power wheelchair is eligible for purchase, associated wheelchair accessories are also eligible for purchase; the wheelchair and accessories should be submitted on the same claim to avoid unnecessary denials.

Claim submission guidance for purchased power wheelchairs and accessories

Billing Rule

Submit purchased power wheelchair and accessories on same claim

When a class 2 or class 3 power wheelchair is eligible for purchase, the associated wheelchair accessories are also eligible for purchase; submit the wheelchair and accessories on the same claim to avoid unnecessary denials.

Submit the power wheelchair and all associated accessories together on a single claim when purchase is allowed.

Purchase eligibility and claim submission

DefinitionWhen a class 2 or class 3 power wheelchair is eligible for purchase, the associated wheelchair accessories are also eligible for purchase.

Claim submission instructionThe wheelchair and accessories should be submitted on the same claim to avoid unnecessary denials.

ScopeApplies to Medicare Advantage capped rental items and associated accessory purchase eligibility for Highmark BlueShield NENY members (billing and claims processing).

Action for providersEnsure purchased power wheelchairs and all related accessories are billed on a single claim rather than separate rental/purchase claims.

PurposePrevent denials by aligning purchase eligibility and claim submission for class 2 and class 3 power wheelchairs and accessories.