Currentmoda_health_plan_incPolicy N/A

Push-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair Accessory

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Coverage policy for push-rim activated power-assist devices (HCPCS E0986) used to convert manual wheelchairs for Moda Health members, defining medical necessity criteria, documentation and prior authorization requirements that affect suppliers and clinicians ordering the device.

Policy Summary

Payermoda_health_plan_inc

PolicyPush-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair Accessory

Policy CodePolicy N/A

Change TypeNo material change

Effective DateAug 13, 2026

Last ReviewJul 22, 2026

Next Review DateJul 22, 2026

Key ActionObtain prior authorization with chart notes and a specialty evaluation documenting need for the device in the member's home.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

E0986HCPCS code covered

1 yearMin self-propelling duration

RESNA ATPSupplier must employ

Chart notesRequired with PA

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Currentmoda_health_plan_incPolicy N/A

Push-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair Accessory

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Sign up for all moda_health_plan_inc policy alerts

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Policy Summary

Payermoda_health_plan_inc

PolicyPush-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair Accessory

Policy CodePolicy N/A

Change TypeNo material change

Effective DateAug 13, 2026

Last ReviewJul 22, 2026

Next Review DateJul 22, 2026

Key ActionObtain prior authorization with chart notes and a specialty evaluation documenting need for the device in the member's home.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

E0986HCPCS code covered

1 yearMin self-propelling duration

RESNA ATPSupplier must employ

Chart notesRequired with PA

Coverage Criteria & Medical Necessity

COVERAGE CRITERIA

Covered when ALL of the following are met

Overall medical necessity

Mobility limitation definition: Mobility limitation either: prevents accomplishing an MRADL entirely; places member at heightened risk of morbidity/mortality performing an MRADL; or prevents completing an MRADL within a reasonable time frame
II.a.i-iii
Conservative measure: Member's mobility limitation cannot be sufficiently and safely resolved by an appropriately fitted cane or walker
II.b
Upper extremity function: Member lacks sufficient upper extremity function to self-propel an optimally configured manual wheelchair in the home to perform MRADLs during a typical day
Includes limitations of strength, endurance, ROM, coordination, pain, deformity, or absence of limb; 'optimally configured' defined by appropriate wheelbase, device weight, seating options, and non-powered accessories (II.c,i-ii)
Experience: Member has been self-propelling in a manual wheelchair for at least one year>= 1 year
II.d
Specialty evaluation: Member has had a specialty evaluation by a licensed/certified professional (e.g., PT or OT) or a practitioner trained in rehabilitation wheelchair evaluations that documents need for the device in the member's home
Evaluator may have no financial relationship with the supplier (II.e)
Supplier qualifications: Wheelchair provided by a supplier that employs a RESNA-certified Assistive Technology Professional (ATP) specializing in wheelchairs with direct, in-person involvement in selection
II.f

Operational note: Coverage applies only when ALL above conditions are satisfied; failure to meet any requirement renders device not medically necessary

See policy criteria

The policy requires that the member’s mobility limitation cannot be sufficiently and safely resolved by an appropriately fitted cane or walker before a push‑rim activated power‑assist device (E0986) will be considered. This limitation functions as an exclusionary check within the medical necessity criteria: if an appropriately fitted cane or walker would adequately and safely address the MRADL limitation, the power‑assist device is not indicated. The requirement helps ensure the device is reserved for members with persistent upper‑extremity impairments or functional needs that cannot be met with simpler ambulatory aids.

If a request does not meet ALL required criteria, the device is not considered medically necessary. Common reasons for denial include: insufficient upper extremity impairment to prevent self‑propulsion of an optimally configured manual wheelchair, less than one year of self‑propelling experience, absence of a specialty evaluation documenting need in the member’s home, or the limitation being resolvable with an appropriately fitted cane or walker. Prior authorization requests missing the required documentation risk denial (see documentation requirements).

Eligibility for E0986

Medical necessity requires ALL of the following

DME medical necessity: Member with MRADL-limiting mobility impairment; limitation not resolved by cane or walker; insufficient upper extremity function to self-propel an optimally configured manual wheelchair; has been self-propelling for >=1 year; specialty evaluation documents need; supplier employs RESNA-certified ATP with in-person involvement

Extracted from II.a–f

Coding

Covered HCPCS CodesHCPCSCovered

E0986

Manual Wheelchair Accessory, Push Rim-Activated Power-Assist System

Not Covered CodesHCPCSNot Covered

No codes listed

Applicable Diagnosis Codes (appendix)ICD-10

No codes listed

Provider Actions & Prior Authorization

Prior Authorization

Prior authorization required with chart notes and specialty evaluation

Prior authorization is required for HCPCS E0986. Submit the prior authorization request with the chart notes and the specialty evaluation documenting the member’s need for the device in the member’s home.

Request must identify the requested HCPCS (E0986) and clinical justification.

Step Therapy

Document failure of cane or walker to resolve limitation

Demonstrate that the member’s mobility limitation cannot be sufficiently and safely resolved by an appropriately fitted cane or walker; coverage requires this conservative measure has been considered and found inadequate.

This is an explicit coverage requirement: “The member's mobility limitation cannot be sufficiently and safely resolved by the use of an appropriately fitted cane or walker.”

Documentation Required for Prior Authorization

Note

Submit chart notes and a specialty evaluation documenting diagnosis, abilities/limitations, prognosis, and past experience

Include chart notes plus a specialty evaluation that documents diagnosis, the member’s abilities and limitations, expected prognosis, and past experience with similar equipment when submitting prior authorization.

Specialty evaluation should be performed by a licensed/certified medical professional (PT/OT) or a practitioner with specific training and experience in rehabilitation wheelchair evaluations.
The evaluation must document the need for the device in the member’s home; evaluator may have no financial relationship with the supplier.

Definitions

Push-rim activated power-assist device (E0986) — definition

DevicePush-rim activated power-assist device — wheel-mounted system with sensors in specially designed wheels that detect force exerted on the wheel and motors in each wheel provide propulsive and/or braking force.

HCPCS codeE0986

HCPCS descriptorManual Wheelchair Accessory, Push Rim-Activated Power-Assist System; E0986 is all-inclusive of components (drive wheels, batteries, chargers, controls, mounting hardware, etc.) included in one unit of service.

MRADLs — mobility-related activities of daily living

DefinitionMobility-related activities of daily living (MRADLs) — activities such as toileting, dressing, grooming, and bathing in customary locations in the home.

Relevance to coverage

Medical Necessity Details

Eligibility for E0986

Medical necessity requires ALL of the following

Extracted from II.a–f

Rental and Purchase Rules

HCPCS	Rule
E0986	Purchase — HCPCS E0986 is all‑inclusive for a manual wheelchair conversion (includes drive wheels, batteries, chargers, controls, mounting hardware, and other components); the code is billed as purchase rather than rental per policy.

Replacement Rules

E0986 — replacement details

Replacement interval specifiedNone specified in the policy for HCPCS E0986.

ImplicationPolicy does not define a specific time-based replacement interval; replacement decisions would rely on clinical need and supplier documentation.

Code inclusivityE0986 is all-inclusive of components for a manual wheelchair conversion; replacement requests should consider that components are included in the single code's unit of service.

Background

Push‑rim activated power‑assist devices are wheel‑mounted systems in which sensors embedded in specially designed wheels detect force applied to the push rim and motors in each wheel provide additional propulsive and/or braking force. They convert an existing manual wheelchair into a powered‑assist configuration so that users with upper‑extremity strength, endurance, range‑of‑motion, coordination, pain, deformity, or limb absence issues can more safely and effectively perform mobility‑related activities of daily living (MRADLs) in the home.

Not Covered

This section is intentionally present for recordkeeping. There are no specific HCPCS codes listed as not covered in this document.