K0802 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS Level II K0802: Power Operated Vehicle, Very Heavy Duty 451–600 lb

HCPCS Level II code K0802 designates a power-operated vehicle (group 1 very heavy duty) with patient weight capacity of 451 to 600 pounds. This code identifies bariatric power mobility devices used to support independence and mobility for individuals who require higher weight capacity. Nationally, such equipment is an important component of durable medical equipment coverage and access to mobility for patients with obesity or other conditions affecting mobility.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what K0802 represents, typical sites of service, and the clinical context for use. The publication provides benchmarking context where available, summarizes common billing considerations, and outlines policy and coverage elements relevant to payers listed above.

This summary is intended for clinicians, billing professionals, and policy analysts seeking a national perspective on the classification and administrative handling of high-capacity power mobility devices. Data not available in the input is noted where applicable in detailed sections of the publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0802HCPCS Level IIDurable Medical EquipmentPower Mobility DeviceBariatric EquipmentMobility AidHome HealthMedical BillingMedical Policy

Billing Code Overview

HCPCS Level II code K0802 describes a power operated vehicle, group 1 very heavy duty, with a patient weight capacity of 451 to 600 pounds. This equipment classification indicates a durable medical equipment item designed for bariatric mobility support.

Service type: Durable medical equipment (power mobility device)
Typical site of service: Home or community use for mobility and activities of daily living

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with morbid obesity (BMI >40) and mobility-limiting osteoarthritis presents to an outpatient durable medical equipment (DME) clinic after discharge from hospital following bariatric surgery. The patient requires a motorized mobility device rated for a patient weight capacity of 451 to 600 pounds. The DME clinical workflow includes an initial evaluation by a physical or occupational therapist to document functional limitations (gait instability, inability to ambulate household distances, risk of falls), a physician face-to-face or telehealth visit to certify medical necessity, selection of a Group 1 very heavy duty power-operated vehicle (K0802) that meets weight-capacity and seat dimensions, delivery and in-home setup by a DME supplier, patient and caregiver training on device operation and safety, and follow-up to verify safe use and document outcomes for coverage and durable medical equipment records.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	When the supplier provides a vehicle with fewer features than originally documented or requested (partial delivery of functionality).
`53`

HCPCS K0812: Power Operated Vehicle, Not Otherwise Classified

HCPCS-K0890-POWER-WHEELCHAIR-GROUP-5-PEDIATRIC

HCPCS K0890: Pediatric Group 5 Power Wheelchair, Single Power Option

HCPCS-K0053-ELEVATING-ARTICULATING-FOOTREST

HCPCS K0053: Elevating Articulating (Telescoping) Footrest

HCPCS-K0002-STANDARD-HEMI-LOW-SEAT-WHEELCHAIR

HCPCS K0002: Standard Hemi (Low Seat) Wheelchair

HCPCS-K0607-REPLACEMENT-AED-GARMENT-BATTERY

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

HCPCS-K0669-WHEELCHAIR-SEAT-BACK-CUSHION-UNCLASSIFIED

HCPCS K0669: Wheelchair Seat or Back Cushion, Unclassified

HCPCS-K0740-OXYGEN-EQUIPMENT-TECHNICIAN-LABOR-REPAIR-15MIN

HCPCS K0740: Technician Labor for Oxygen Equipment Repair, per 15 min

HCPCS-K0077-FRONT-CASTER-ASSEMBLY-SOLID-TIRE-REPLACEMENT

HCPCS K0077: Front Caster Assembly with Solid Tire, Replacement

HCPCS-K0554-THERAPEUTIC-GLUCOSE-CONTINUOUS-MONITOR-RECEIVER

HCPCS K0554: Receiver for Therapeutic Continuous Glucose Monitor

HCPCS-K0820-POWER-WHEELCHAIR-GROUP-2-PORTABLE-300LB-CAPACITY

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

Showing 1–10 of 135

Taxonomy Code	Specialty	Notes
`207Q00000X`	Physical Therapist	Performs mobility assessment, functional evaluation, and equipment selection recommendations.
`208000000X`	Occupational Therapist	Evaluates activities of daily living, seating needs, and recommends accessories and training.
`2086S0105X`	Assistive Technology Supplier	Certified DME supplier responsible for fitting, delivery, and modifications of `K0802`.
`207R00000X`	Physician, Rehabilitation Medicine (Physiatrist)	Provides medical necessity certification and oversight for mobility equipment.
`207L00000X`	Physician, Family Medicine	May provide the face-to-face certification and documentation of medical necessity.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E66.01`	Morbid (severe) obesity due to excess calories	High body weight requiring a power-operated vehicle with capacity `451 to 600 pounds`.
`M16.11`	Unilateral primary osteoarthritis, right hip	Severe lower extremity joint disease causing mobility limitation leading to need for powered mobility.
`M17.11`	Unilateral primary osteoarthritis, right knee	Knee osteoarthritis limiting ambulation and safe use of standard mobility aids.
`G82.20`	Paraplegia, unspecified	Neurological impairment causing inability to ambulate, necessitating power-operated vehicle.
`R26.2`	Difficulty in walking, not elsewhere classified	Functional gait impairment commonly documented to support power wheelchair need.
`Z74.01`	Bed confined status	Severe immobility where powered mobility device is necessary for activities of daily living.
`Z99.3`	Dependence on wheelchair	Indicates ongoing need for wheeled mobility device and supports durable medical equipment provision.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97161`	Physical therapy evaluation: low complexity	Used when a physical therapist performs the initial mobility assessment that supports `K0802` medical necessity.
`97162`	Physical therapy evaluation: moderate complexity	Used for more complex functional assessments when comorbidities and multiple deficits are present prior to ordering a Group 1 very heavy duty power-operated vehicle.
`97530`	Therapeutic activities, direct (one-on-one)	May be billed during training sessions focused on mobility, transfers, and safe operation of the power-operated vehicle.
`99456`	Work-related or medical disability examination	Used when an employer or insurer requires functional capacity documentation related to provision of specialized mobility equipment.
`99070`	Supplies and materials (used with DME billing when appropriate)	Used for non-covered ancillary supplies or specialized accessories associated with delivery of `K0802` when billed to the medical record.
`99499`	Unlisted evaluation and management service	Occasionally used for nonstandard multidisciplinary coordination related to high-capacity power mobility provisioning.

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