Summary & Overview

HCPCS K0019: Arm Pad, Replacement Only, Each

HCPCS Level II code K0019 designates an arm pad provided as a replacement accessory for durable medical equipment. Replacement components like arm pads support patient comfort, skin protection, and functional use of seating or supportive devices and are commonly billed separately from the primary equipment. Nationally, replacement accessory codes matter because they affect coverage policies, supplier billing practices, and beneficiary out-of-pocket costs for repairs and parts.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of what K0019 represents in clinical and supply-chain terms, typical sites of service, and what benchmarks and policy considerations commonly accompany accessory and replacement billing for durable medical equipment. The publication summarizes common payer approaches to accessory reimbursement, typical documentation expectations, and areas where policy updates or payer-specific rules often appear. Where input data is not available, the report notes those gaps as "Data not available in the input."

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0019HCPCS Level IIdurable medical equipmentreplacement accessoryarm padDME suppliesoutpatientbilling

Billing Code Overview

HCPCS Level II code K0019 describes an arm pad, replacement only, each. This item is a replacement accessory intended to serve as a protective or comfort padding component for durable medical equipment that supports the upper extremity.

Service type: Durable medical equipment accessory/replacement
Typical site of service: Durable medical equipment suppliers, outpatient clinics, home use

Clinical & Coding Specifications

Clinical Context

A patient with an established wheelchair cushion system presents to durable medical equipment (DME) services or an outpatient rehabilitation clinic for replacement of a worn or damaged arm pad. The typical patient is an adult or pediatric wheelchair user who reports discomfort, skin irritation, or loss of padding integrity on the wheelchair armrest. A DME technician or occupational therapist evaluates the arm pad to confirm size, mounting compatibility, and that only the arm pad component requires replacement rather than the entire arm assembly. Documentation includes the patient identifier, device make/model, reason for replacement (wear, damage, contamination, pressure concerns), date of service, description of the replaced part (K0019), and verification that the replacement is compatible with the existing wheelchair. The supplier dispenses and fits the arm pad, demonstrates use and care to the patient or caregiver, and submits the claim to the patient’s payor with appropriate supporting documentation and any applicable modifier(s). Typical sites of service include outpatient DME supplier locations, inpatient rehabilitation facilities when coordinating DME prior to discharge, and home visits by DME providers for patients unable to travel.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	Use when the arm pad replacement is for the left armrest.
`RT`	Right side	Use when the arm pad replacement is for the right armrest.
`GN`	Service delivered under an outpatient speech-language pathology plan of care	Not typically used for `K0019`; include only if payor requires for a bundled therapy-supplied item.
`RB`	Replacement of DME due to prior rental	Use when the item is billed as a purchase following a rental period per payor policy.
`NU`	New equipment	Use when the arm pad is billed as new replacement part (standard use for replacement parts).
`RR`	Rental return	Use if item was previously rented and now returned; rarely used for single-part replacements.
`KS`	Item-specific coding clarification	Use when payor requires a supplier-specific code modifier (apply only if payer recognizes).
`KX`	Requirements specified in the medical policy have been met	Use when payer policy requires attestation that coverage criteria are met.
`GY`	Item statutorily excluded or not covered by Medicare	Use to indicate an item is not covered by Medicare when submitting to a non-Medicare payor.
`GZ`	Item expected to be denied as not reasonable and necessary	Use when supplier acknowledges that medical necessity is not met but requests claim submission.

Taxonomy Code	Specialty	Notes
`233700000X`	Durable Medical Equipment Supplier	Primary provider type supplying `K0019`.
`261QM0800X`	Occupational Therapist	Performs armrest assessment and documents functional need for replacement.
`207R00000X`	Physical Medicine and Rehabilitation Physician	Provides clinical supervision or prescription for DME when required.
`333600000X`	Prosthetist/Orthotist	May specify compatible arm pad components for specialized seating systems.
`251B00000X`	Home Health Agency	Coordinates home delivery and fitting for patients discharged with DME.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z99.3`	Dependence on wheelchair	Common underlying condition indicating need for wheelchair component maintenance, including arm pad replacement.
`L89.9`	Pressure ulcer, unspecified	Patients with skin breakdown risk require intact padding; worn arm pads may contribute to pressure areas.
`M19.90`	Osteoarthritis, unspecified site	Shoulder or elbow pain from joint disease may prompt need for improved arm support on wheelchair.
`G82.50`	Paraplegia, unspecified	Mobility impairment increases wheelchair use and wear on arm components.
`R29.6`	Repeated falls	Patients with balance issues may need robust arm supports and replacement pads for safety and comfort.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic(s) and/or prosthetic(s) management and training, upper extremity, initial encounter	Used when clinician provides training related to armrest modification or positioning after replacement.
`97530`	Therapeutic activities, direct (one-on-one) patient contact	May be billed when occupational therapy addresses functional transfers or pressure relief with the new arm pad.
`99070`	Supplies and materials (except spectacles), used by the physician, not for patient use	Occasionally used by suppliers for noncapital supplies associated with fitting; payer-specific.
`99499`	Unlisted preventive medicine service	Rarely used for documentation of nonstandard device fitting services when no specific CPT exists.
`T1019`	Mileage, Round trip	Used by DME suppliers or home health when billing for travel related to home delivery and fitting (HCPCS/other payor-specific).