K0037 High-Mount Flip-Up Footrest Reimbursement | OpenPayer

Summary & Overview

HCPCS K0037: High Mount Flip-Up Footrest, Each

HCPCS Level II code K0037 denotes a high mount flip-up footrest, billed per each unit as a durable medical equipment accessory for mobility devices. Nationally, this code matters because it defines coverage and billing for a common mobility-device component that affects patient mobility, device functionality, and equipment maintenance workflows. Clear coding supports accurate claims processing and proper supply of accessories that can affect safety and independence for beneficiaries. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical settings for use, coverage considerations tied to major payers, and commonly reported billing practices. The publication summarizes available benchmarks where present, notes common modifier usage from input data, and highlights areas with Data not available in the input when payer-specific rates or taxonomies are not provided. This resource is intended to help billing staff, DME suppliers, and policy analysts quickly understand what K0037 represents, where it is typically used, and which major national payers are relevant for claims and coverage conversations.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0037HCPCS Level IIdurable medical equipmentmobility accessorywheelchair partsfootrest

Billing Code Overview

HCPCS Level II code K0037 describes a high mount flip-up footrest, each. This item is an individual footrest component designed to mount at a higher position on a mobility device and to flip upward for clearance when not in use. Service type: durable medical equipment (DME) accessory. Typical site of service: durable medical equipment supply or outpatient equipment fitting on mobility devices such as wheelchairs or scooters.

Clinical & Coding Specifications

Clinical Context

A patient who uses a manual or power wheelchair requires a K0037 high-mount flip-up footrest to support lower extremities and enable safe transfers. Typical patients include individuals with spinal cord injury, lower-limb amputation, stroke with hemiparesis, or severe lower-extremity weakness and contractures who cannot maintain a safe foot position on a standard footplate. The clinical workflow begins with a durable medical equipment (DME) evaluation by a physical therapist or rehabilitation physician to document functional deficits, measurements, and justification for a high-mount flip-up footrest. The DME supplier verifies wheelchair make/model compatibility, obtains clinician documentation and any necessary prior authorization, and fits the footrest to ensure clearance during transfers and compatibility with seat height and leg rests. Follow-up includes instructions to the patient and caregiver on use, periodic inspection for wear, and replacement ordering when clinically indicated.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	Use when a provision of the footrest is partially completed or a component is not supplied as originally planned.
`53`

HCPCS K0880: Power Wheelchair, Very Heavy Duty, 451–600 lb

HCPCS-K0800-POWER-OPERATED-VEHICLE-GROUP-1-UP-TO-300LBS

HCPCS K0800: Power Operated Vehicle, Group 1 (≤300 lb)

HCPCS-K0868-POWER-WHEELCHAIR-GROUP-4-300-LB-CAPACITY

HCPCS K0868: Power Wheelchair Group 4, 300 lb Capacity

HCPCS-K0879-POWER-WHEELCHAIR-HEAVY-DUTY-301-450-LB-CAPACITY

HCPCS K0879: Power Wheelchair, Heavy Duty, 301–450 lb Capacity

HCPCS-LEVEL-II-K0739-DME-REPAIR-TECHNICIAN-LABOR-15-MIN

HCPCS Level II K0739: Technician Labor for DME Repair, per 15 Minutes

HCPCS-K0607-REPLACEMENT-AED-GARMENT-BATTERY

HCPCS K0607: Replacement Battery for Garment-Style Automated External Defibrillator

HCPCS-K0015-DETACHABLE-NON-ADJUSTABLE-ARMREST-REPLACEMENT

HCPCS K0015: Detachable Non-Adjustable Armrest, Replacement Only, Each

HCPCS-K0069-REAR-WHEEL-ASSEMBLY-SOLID-TIRE-REPLACEMENT

HCPCS K0069: Rear Wheel Assembly with Solid Tire, Replacement Only

HCPCS-K0738-PORTABLE-HOME-OXYGEN-COMPRESSOR-RENTAL

HCPCS K0738: Portable Home Oxygen Compressor Rental

HCPCS-K0462-TEMPORARY-REPLACEMENT-PATIENT-OWNED-EQUIPMENT-REPAIR

HCPCS K0462: Temporary Replacement for Patient-Owned Equipment Being Repaired

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Taxonomy Code	Specialty	Notes
`208LP2900X`	Physical Therapist	Performs functional assessment and measurement for footrest fitting.
`207R00000X`	Rehabilitation Physician (Physical Medicine & Rehabilitation)	Provides medical necessity documentation and prescriptions for DME.
`101Y00000X`	Orthotist/Prosthetist	May assist with custom mounting or interface between prosthetic limbs and footrest.
`332B00000X`	Durable Medical Equipment Supplier	Supplies, fits, and follows up on the footrest installation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M62.81`	Muscle weakness (generalized)	Patients with generalized lower-extremity weakness may require elevated foot support for alignment and safety.
`G82.20`	Paraplegia, unspecified	Wheelchair users with paraplegia commonly need specialized footrests to maintain limb position and enable transfers.
`S48.011A`	Strain of muscle, fascia and tendon of right shoulder, initial encounter	Data not available in the input.
`Z96.641`	Presence of right artificial knee joint	Prosthetic or joint replacement patients may need customized foot support; included when clinically applicable.
`I69.351`	Dysphagia following cerebral infarction	Neurologic deficits after stroke often co-occur with impaired lower-limb control requiring footrest support.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97530`	Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance)	Used by therapists during wheelchair mobility and transfer training after footrest fitting to achieve functional goals.
`97001`	Physical therapy evaluation	Performed by a physical therapist to assess need for DME such as a high-mount flip-up footrest and to document measurements and goals.
`97161`	Physical therapy evaluation, low complexity	Alternative PT evaluation code used depending on complexity of the assessment leading to DME prescription.
`97760`	Orthotic(s)/prosthetic(s) management and training (including assessment and documentation)	May be used when training is provided for use of wheelchair accessories or when integration with prosthetic devices is required.
`99070`	Supplies and materials (eg, DME) provided by the physician over and above those usually included with the office visit and incident to services	Rarely used; may apply when clinicians supply small ancillary components or replacement parts during an encounter.

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