K0069 Rear Wheel Assembly HCPCS Reimbursement | OpenPayer

Summary & Overview

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

HCPCS Level II code K0069 designates a complete rear wheel assembly with a solid tire (spokes or molded) intended for replacement on mobility devices such as wheelchairs. Nationally, this code matters because replacement parts for durable medical equipment (DME) are a frequent source of billing activity and can affect device availability, patient mobility, and cost management across settings. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find an overview of what HCPCS Level II code K0069 covers, typical sites of service, and the clinical context for when a complete rear wheel assembly is supplied. The publication presents benchmarks for coverage and payment patterns, highlights common billing considerations, and summarizes relevant policy updates affecting DME replacement parts. It also provides practical details on coding usage, common modifiers in claims workflows, and implications for suppliers and facility billing operations. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0069HCPCS Level IIdurable medical equipmentwheelchair partsDME replacementmedical billingsupply chainrepair and maintenance

Billing Code Overview

HCPCS Level II code K0069 describes a rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each. This supplies a complete replacement rear wheel for mobility devices such as wheelchairs and some transport chairs. The service type is durable medical equipment replacement parts, and the typical site of service is durable medical equipment suppliers, outpatient clinics, or on-site repair services where mobility devices are serviced or maintained.

Clinical & Coding Specifications

Clinical Context

A patient who uses a manual wheelchair presents to an orthopedic repair clinic or durable medical equipment (DME) shop because the rear wheel on their wheelchair is damaged or worn. Typical patients include adults with mobility impairment due to spinal cord injury, stroke, multiple sclerosis, or degenerative joint disease who report instability, vibration, or a flat/failed tire on one side. The clinical workflow: intake and inspection of the wheelchair, verification of wheelchair make/model and warranty, assessment of the rear wheel assembly (hub, spokes or molded rim, and solid tire), selection of the correct replacement K0069 rear wheel assembly, documentation of medical necessity and size/specifications, replacement of the wheel on-site by a trained technician or clinician, functional test for alignment and secure attachment, and billing to the patient’s payor with applicable modifier(s). Typical site of service is a DME supplier, outpatient orthopedic clinic, or rehabilitation prosthetics/orthotics shop. Durable medical equipment suppliers and wheelchair service providers perform the repair or replacement; clinicians (rehabilitation physicians or therapists) may document medical necessity when required for coverage determination.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	Use when a partial replacement or limited service was performed instead of full replacement of both wheels or full assembly.

HCPCS K0860: Power Wheelchair, Very Heavy Duty, 451–600 lb

HCPCS-K0827-POWER-WHEELCHAIR-VERY-HEAVY-DUTY-451-600-LB

HCPCS K0827: Power Wheelchair, Very Heavy Duty, 451–600 lb

HCPCS-K0743-PORTABLE-HOME-SUCTION-PUMP-WOUND-CARE

HCPCS K0743: Portable Home Suction Pump for Wound Care

HCPCS-K0014-POWER-WHEELCHAIR-BASE

HCPCS K0014: Other Motorized/Power Wheelchair Base

HCPCS-K0850-POWER-WHEELCHAIR-GROUP-3-HEAVY-DUTY-301-450-LB

HCPCS K0850: Power Wheelchair Group 3 Heavy Duty, 301–450 lb

HCPCS-K0853-POWER-WHEELCHAIR-VERY-HEAVY-DUTY-CAPTAINS-CHAIR-451-600LBS

HCPCS K0853: Power Wheelchair, Very Heavy Duty Captains Chair

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

HCPCS K0868: Power Wheelchair Group 4, 300 lb Capacity

HCPCS-K0877-POWER-WHEELCHAIR-GROUP-4-STANDARD-300LB-CAPACITY

HCPCS Level II K0877: Power Wheelchair Group 4 Standard, 300 lb Capacity

HCPCS-K0051-CAM-RELEASE-ASSEMBLY-FOOTREST-LEGREST-REPLACEMENT

HCPCS K0051: Cam Release Assembly for Footrest or Legrest, Replacement Only

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

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

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Taxonomy Code	Specialty	Notes
`225100000X`	Physical Medicine & Rehabilitation (Physiatry)	Physiatrists document functional need and oversee wheelchair provisioning and repairs.
`333600000X`	Orthopedic Surgery	Orthopedic clinicians evaluate device-related musculoskeletal issues and may authorize replacements.
`333700000X`	Prosthetics/Orthotics (DME Supplier)	Providers who perform fitting, repair, and replacement of wheelchair components.
`173V00000X`	Occupational Therapy	Occupational therapists assess mobility needs and recommend equipment adjustments.
`2254C0002X`	Assistive Technology Supplier	Suppliers specializing in mobility devices and wheelchair parts.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z99.3`	Dependence on wheelchair	Common reason for wheelchair component replacement due to chronic use and wear.
`S14.1XXA`	Injury of cervical spinal cord, initial encounter	Patients with spinal cord injury frequently use wheelchairs and may require wheel replacement.
`G82.20`	Paraplegia, unspecified	Mobility impairment leading to regular wheelchair use and need for maintenance.
`I69.391`	Other sequelae of cerebral infarction: hemiplegia and hemiparesis of left dominant side	Stroke survivors using wheelchairs may require component replacement for safe mobility.
`M48.06`	Spinal stenosis, thoracic region	Progressive conditions that result in wheelchair use and equipment maintenance needs.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97530`	Therapeutic activities, direct (one-on-one) patient contact by the provider; each 15 minutes	Performed by occupational or physical therapists before or after wheel replacement to assess functional mobility and seating impact.
`97760`	Orthotic(s) management and training, initial encounter	Used when wheelchair component replacement is part of a broader orthotic/assistive device management and training plan.
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or procedure	Used to report additional supplies or replacement parts supplied during the service when applicable.
`B4150`	Data not available in the input.	Data not available in the input.
`S5160`	Repair or replacement of wheelchair part	HCPCS S-code used in some facility billing scenarios to report repair services related to wheelchairs.

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