K0070 Rear Wheel Assembly HCPCS: Reimbursement

HCPCS Level II code K0070 represents a complete rear wheel assembly with a pneumatic tire (spoked or molded) intended for replacement on a wheelchair or similar mobility device. Nationally, accurate use of this code supports appropriate billing for durable medical equipment (DME) component replacement and impacts coverage determinations, claims processing, and provider reimbursement for mobility-device maintenance.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for replacement rear wheels, typical sites of service, and payer coverage considerations. The publication outlines common billing and coding considerations, comparative benchmarks where available, and recent policy updates affecting DME component reimbursement. It also provides practical guidance on documentation elements that payers commonly require for medical necessity review and claims adjudication.

This summary is aimed at billing managers, DME suppliers, and compliance teams seeking a national-level reference for HCPCS Level II code K0070, including how payers approach coverage and what information is typically needed on the claim and in supporting documentation.

Billing Code Overview

HCPCS Level II code K0070 describes a rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each. This item is a component-level durable medical equipment (DME) supply intended to replace the rear wheel on a wheelchair or similar mobility device.

Service type: Durable Medical Equipment component replacement
Typical site of service: Outpatient equipment replacement settings, durable medical equipment suppliers, home setting when delivered to the beneficiary

Clinical Context

A patient who uses a manual or power wheelchair presents to durable medical equipment (DME) services because the rear wheel assembly on their wheelchair is damaged or worn and requires replacement. Typical patients include individuals with mobility-limiting conditions such as spinal cord injury, multiple sclerosis, cerebrovascular accident (stroke), degenerative joint disease, or advanced neuropathy. The clinician or DME technician documents the wheelchair make/model, wheel size, pneumatic tire requirement, and verifies that a complete rear wheel assembly with spokes or molded tire is necessary. The DME supplier orders the replacement part billed with K0070 for the rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each. The service is commonly provided in an outpatient DME setting, the patient’s residence, or a rehabilitation clinic. Billing includes the supplier NPI and taxonomy, the ordering clinician’s information, and any applicable modifier to indicate laterality, professional component, unforeseen circumstances, or reduced services. Medical necessity is supported by documentation of wheel damage, safety concerns, or functional impairment caused by the defective wheel assembly.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	Use when the replacement rear wheel assembly is for the left side of the wheelchair

Taxonomy Code	Specialty	Notes
`334400000X`	Rehabilitation Services, Wheelchair/Pediatric Seating Specialist	Specialists who assess wheelchair fit and order rear wheel replacements
`332B00000X`	Durable Medical Equipment Supplier	DME companies that supply and install replacement wheel assemblies
`261QM0808X`	Physical Therapist	Therapists who identify mobility limitations and recommend equipment replacement
`261QA2300X`	Occupational Therapist	Clinicians who assess activities of daily living impacted by wheelchair component failure
`367A00000X`	Orthotist/Prosthetist	Professionals who may fit and adjust wheelchair components and assemblies

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M19.90`	Osteoarthritis, unspecified site, unspecified	Patients with degenerative joint disease may rely on wheelchairs and require component replacement due to wear
`G82.20`	Paraplegia, unspecified	Individuals with paraplegia commonly use wheelchairs; damaged rear wheel assemblies impair mobility and safety
`G82.50`	Quadriplegia, unspecified	Quadriplegic patients dependent on wheelchair mobility may need replacement wheel assemblies for safety and function
`R26.2`	Difficulty in walking, not elsewhere classified	Progressive gait impairment may lead to increased wheelchair use and subsequent equipment maintenance needs
`M62.81`	Muscle weakness (generalized)	Muscle weakness can increase reliance on wheelchairs and necessitate repairs or replacements of components
`T14.8`	Other injury of unspecified body region	Trauma to wheelchair or its components in an accident may require replacement of the rear wheel assembly
`Z99.3`	Dependence on wheelchair	Directly indicates the patient uses a wheelchair and may require replacement parts for maintenance
`H18.9`	Corneal opacity, unspecified (not related)	Data not available in the input.

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	May be performed by occupational or physical therapists to assess functional impact of a defective wheel and train patient after installation
`97035`	Ultrasound therapy, each 15 minutes	Not typically related; Data not available in the input.
`97760`	Orthotic(s) management and training, initial encounter	May be used if wheelchair seating or mobility orthotic components are adjusted in conjunction with wheel replacement
`99070`	Supplies and materials (except spectacles), provided by physician over and above those usually included with the office visit	Use when additional supplies or small parts are supplied during repair or installation
`A9270`	Non-covered item or service (not a CPT but HCPCS)	Not directly related; Data not available in the input.

OpenPayer

Summary & Overview

HCPCS Level II K0070: Rear Wheel Assembly with Pneumatic Tire