Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesDurable medical equipment (DME) Medicare administrative contractors (MACs)HCPCS hcpcs-k0005-ultralightweight-wheelchair
    Ask Trek AI about this page

    HCPCS Level II K0005: Ultralightweight Wheelchair

    HCPCS Level II code K0005 describes an ultralightweight wheelchair device intended for mobility assistance, categorized as durable medical equipment for patients who require a highly maneuverable, lightweight manual wheelchair; the service type is durable medical equipment (DME) and the typical site of service is home use or community mobility where the patient performs daily activities and ambulation with caregiver or self-propulsion assistance.

    For related coverage guidance, see recent payer policy updates: Hospital Beds Corporate Medical Policy, Patient Lifts, Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure.

    Customize your policy alerts

    Sign up for hcpcs K0005 policy alerts

    Get alerted when payer policies referencing K0005 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A 72-year-old ambulatory-limited patient with progressive osteoarthritis and reduced endurance is evaluated by a physiatrist and an occupational therapist for durable medical equipment. The clinician documents functional deficits in mobility, transfers, and energy conservation and determines that an ultralightweight manual wheelchair is medically necessary to permit participation in community activities and to reduce caregiver burden. A formal mobility assessment, gait and transfer observations, seating and postural needs review, and trial of an ultralightweight chair in the clinic or home environment are performed. The supplier verifies measurements, provides the K0005 ultralightweight wheelchair, completes delivery and setup, gives training to the patient and caregiver on safe propulsion, fit, and maintenance, and documents the medical necessity, product specifications, and education in the medical record. Typical site of service: outpatient clinic, physician office, home assessment, or medical equipment supplier location.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic(s) management and training, upper extremity, lower extremity, and/or trunk, initial encounter; 15 minutesUsed for wheelchair training and functional mobility instruction during initial setup
    97530Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance); each 15 minutesUsed during occupational or physical therapy sessions to improve mobility and transfers with the wheelchair
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesUsed for follow-up face-to-face clinician visits documenting medical necessity for DME
    99455Work-related or medical disability examination by treating physician including completion of work-related activities form, medical records review, and reportMay be used when documenting functional limitations related to mobility for return-to-work or disability paperwork
    E1399Durable medical equipment, miscellaneous (used by some suppliers for accessories not otherwise classified)May be used by suppliers when billing non-standard wheelchair accessories not covered under main HCPCS codes

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    P2Modifier P2 denotes an ASA Physical Status II — a patient with mild systemic disease. Per AMA/AAPC, examples include well-controlled hypertension or diabetes, mild obesity (BMI 30–40), current smoker…- When to use: Append modifier -P2 to anesthesia CPT codes (00100–01999) when the anesthesia provider documents the patient has mild systemic disease (ASA Physical Status II) — for example…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207R00000X
    3336C0002X
    207K00000X
    2471V0106X
    363LA2100X
    207RC0200X
    202D00000X
    173000000X

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 3

    10 rows

    PolicyPayerEffective Date
    Hospital Beds Corporate Medical Policybcbsvermont2027-01-01
    Patient Liftsuniverahealthcare2026-11-16
    Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failureexcellus_health_plan_inc2026-10-15
    Positive Airway Pressure Devices for Pulmonary Disorders Continued RentalCareSource Georgia2026-10-01
    Bone Growth StimulatorsProvidence Health Plan2026-10-01
    Durable Medical Equipment (DME) Medical Necessity and CoverageMass General Brigham Health Plan2026-10-01
    Speech Generating DevicesMass General Brigham Health Plan2026-10-01
    Interferential Stimulation Devices (for home use)Moda Health2026-10-01
    Durable Medical Equipment (DME): Tumor Treating Fields (Alternating Electric Field Therapy) Medical GuidelineWPS Health Insurance2026-10-01
    Durable Medical Equipment (DME): Bone Growth Stimulators Medical GuidelineWPS Health Insurance2026-10-01

    Related Codes

    HCPCS-K0001-STANDARD-WHEELCHAIR-DURABLE-MEDICAL-EQUIPMENT

    HCPCS K0001: Standard Wheelchair

    HCPCS-K0002-STANDARD-HEMI-LOW-SEAT-WHEELCHAIR

    HCPCS K0002: Standard Hemi (Low Seat) Wheelchair

    HCPCS-K0003-LIGHTWEIGHT-WHEELCHAIR

    HCPCS K0003: Lightweight Wheelchair

    HCPCS-K0004-HIGH-STRENGTH-LIGHTWEIGHT-WHEELCHAIR

    HCPCS K0004: High Strength, Lightweight Wheelchair

    HCPCS-K0006-HEAVY-DUTY-WHEELCHAIR

    HCPCS Level II K0006: Heavy Duty Wheelchair

    HCPCS-K0007-EXTRA-HEAVY-DUTY-WHEELCHAIR

    HCPCS Level II K0007: Extra Heavy Duty Wheelchair

    HCPCS-K0008-CUSTOM-MANUAL-WHEELCHAIR

    HCPCS K0008: Custom Manual Wheelchair/Base

    HCPCS-K0009-OTHER-MANUAL-WHEELCHAIR-BASE

    HCPCS K0009: Other Manual Wheelchair/Base

    HCPCS-K0010-STANDARD-WEIGHT-FRAME-POWER-WHEELCHAIR

    HCPCS K0010: Standard Weight Frame Motorized/Power Wheelchair

    HCPCS-K0011-POWER-WHEELCHAIR-PROGRAMMABLE-CONTROLS-TREMOR-DAMPENING

    HCPCS K0011: Motorized/Power Wheelchair with Programmable Controls

    Showing 1–10 of 135

    • More pages

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    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.