K0072 Front Caster Assembly HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS K0072: Front Caster Assembly with Semi-Pneumatic Tire, Replacement Only

HCPCS Level II code K0072 designates a complete front caster assembly with a semi-pneumatic tire provided as a replacement part for wheeled mobility devices. This code is used by durable medical equipment suppliers and clinicians to bill for the single-item replacement of the front caster component, encompassing the wheel, tire, and mounting hardware. Nationally, proper coding of replacement components affects device maintenance, patient mobility continuity, and accurate durable medical equipment (DME) spending capture.

Major payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what K0072 represents clinically and operationally, typical sites of service where this supply is provided, and common billing considerations tied to replacement-component DME coding. The publication summarizes benchmark reimbursement context and payer coverage patterns where available, highlights documentation and billing practice implications for suppliers, and outlines areas where policy or coding clarifications can affect claims processing. Data not available in the input is explicitly noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0072HCPCS Level IIdurable medical equipmentmobility assistive devicereplacement componentfront caster assemblyDME billingmedical supplies

Billing Code Overview

HCPCS Level II code K0072 describes a front caster assembly, complete, with semi-pneumatic tire, replacement only, each. This item is a replacement component for mobility or wheeled-assistive devices that includes the caster, wheel, and associated mounting hardware as a single, complete assembly.

Service type: Durable medical equipment replacement component
Typical site of service: Durable medical equipment suppliers, outpatient clinics, and patient residences where repair or replacement of mobility devices occurs

Clinical & Coding Specifications

Clinical Context

A patient who uses a manual wheelchair presents to an outpatient durable medical equipment (DME) clinic for a repair visit after noticing a bent or worn front caster on their wheelchair. The wheelchair technician inspects the chair, documents that the caster assembly requires full replacement (including semi-pneumatic tire) rather than repair of individual parts, and orders the replacement part. Typical workflow: patient phone or portal triage → appointment with wheelchair technician or DME specialist → clinical and functional assessment (safety, stability, tire wear) → documentation of necessity for replacement part and measurement/specifications → procurement of the K0072 front caster assembly, complete, with semi-pneumatic tire → billing to the patient’s payor with relevant diagnosis and procedure documentation. Typical site of service is an outpatient DME supplier, outpatient clinic, outpatient rehabilitation facility, or the patient’s home when provided under home delivery and repair services.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	When only partial service or replacement is performed compared with the full assembly (rare for a complete replacement)
`53`

HCPCS K0820: Power Wheelchair Group 2 Portable, Up to 300 lb

HCPCS-K0854-POWER-WHEELCHAIR-EXTRA-HEAVY-DUTY-601LBS-PLUS

HCPCS K0854: Power Wheelchair Extra Heavy Duty, 601+ lb Capacity

HCPCS-K0604-REPLACEMENT-LITHIUM-BATTERY-EXTERNAL-INFUSION-PUMP

HCPCS K0604: Replacement Lithium Battery for External Infusion Pump

HCPCS-K0864-POWER-WHEELCHAIR-EXTRA-HEAVY-DUTY-601LBS-PLUS

HCPCS Level II K0864: Power Wheelchair, Extra Heavy Duty, 601+ lbs

HCPCS-K0603-REPLACEMENT-ALKALINE-1-5V-BATTERY-INFUSION-PUMP

HCPCS K0603: Replacement Alkaline Battery for Patient-Owned Infusion Pump

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

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

HCPCS-K0869-POWER-WHEELCHAIR-GROUP-4-CAPTAINS-CHAIR-300LB-CAPACITY

HCPCS K0869: Power Wheelchair Group 4, Captain's Chair, ≤300 lb

HCPCS-K0885-POWER-WHEELCHAIR-GROUP-4-CAPTAINS-CHAIR-300LB-CAPACITY

HCPCS K0885: Power Wheelchair Group 4, Captain's Chair, 300 lb Capacity

HCPCS-K0871-POWER-WHEELCHAIR-GROUP-4-VERY-HEAVY-DUTY-451-600-LB

HCPCS K0871: Power Wheelchair Group 4, 451–600 lb Capacity

HCPCS-K0004-HIGH-STRENGTH-LIGHTWEIGHT-WHEELCHAIR

HCPCS K0004: High Strength, Lightweight Wheelchair

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Taxonomy Code	Specialty	Notes
`Data not available in the input.`	`Orthotist/Prosthetist`	`Common provider specialty for wheelchair fitting and part replacement`
`Data not available in the input.`	`Durable Medical Equipment Supplier`	`Primary supplier responsible for parts and repairs`
`Data not available in the input.`	`Physical Medicine & Rehabilitation (Physiatry)`	`Clinicians who may order or document functional need for replacement`
`Data not available in the input.`	`Occupational Therapy`	`Therapists who assess seating and mobility needs`

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M99.01`	Segmental and somatic dysfunction of cervical region	Mobility impairments that may necessitate wheelchair use and periodic replacement of components
`G82.50`	Quadriplegia, unspecified	Neurologic impairment commonly associated with long-term wheelchair dependence and equipment wear
`G82.20`	Paraplegia, unspecified	Long-term wheelchair use leading to component wear or damage requiring replacement
`R26.89`	Other abnormalities of gait and mobility	Mobility limitations where wheelchair maintenance supports safe mobility
`M62.81`	Muscle weakness (generalized)	Weakness that may lead to wheelchair reliance and need for equipment maintenance

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97542`	Wheelchair management: fitting and training	Performed before or after replacement to assess function and ensure safe use of new caster assembly
`97760`	Orthotic and prosthetic management and training, initial	May be used when a clinician provides training or adjustment after hardware replacement
`99070`	Supplies and materials (used with DME billing)	May be used to bill non-standard supplies or small parts associated with the replacement when payer allows
`T1999`	DME miscellaneous (not otherwise classified) — HCPCS-type code occasionally used by payors	Used by some payors for unique parts or non-covered DME items when specific HCPCS is not available
`A9270`	Non-covered item or service	Used by some suppliers to indicate an item not covered by Medicare when billing the beneficiary

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