K0812 Power Operated Vehicle HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS K0812: Power Operated Vehicle, Not Otherwise Classified

HCPCS Level II code K0812 denotes a power operated vehicle, not otherwise classified — a category of durable medical equipment for powered mobility when standard devices are unsuitable. Nationally, this code matters because it covers non-standard power mobility solutions that can affect access to independent mobility for beneficiaries, influence durable medical equipment (DME) supply chains, and intersect with coverage policies across major payers.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of coverage considerations, comparative benchmarks where available, and clinical context for when a non-standard power operated vehicle might be used. The publication summarizes common billing practices and payer coverage patterns, highlights policy factors that affect authorization and reimbursement, and explains service-line implications for DME providers and care teams.

The report is intended to inform revenue cycle, compliance, and clinical staff about how K0812 is classified, typical sites of use, and what to expect when navigating payer policies for non-standard powered mobility devices. Data not available in the input where explicit payer-specific rates, diagnostic mappings, or utilization statistics would normally be noted.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0812HCPCS Level IIdurable medical equipmentpower mobilitywheelchairDME billingmedical policyauthorizationreimbursement

Billing Code Overview

HCPCS Level II code K0812 represents a power operated vehicle, not otherwise classified. This item is categorized as a durable medical equipment product intended to provide powered mobility to individuals with mobility limitations when standard power-operated vehicles do not fit clinical or functional needs.

Service Type: Durable Medical Equipment (power mobility device)

Typical Site of Service: Home or community settings

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with mobility impairment from neurologic or musculoskeletal conditions (for example, spinal cord injury, multiple sclerosis, stroke, severe osteoarthritis, or limb amputation) who requires a customized power operated vehicle to maintain community ambulation and activities of daily living. The patient is evaluated in a durable medical equipment (DME) clinic or outpatient rehabilitation setting by a rehabilitation physician, physical therapist, and DME technician. Clinical workflow: initial evaluation documents functional limitations, mobility goals, home and community environment assessment, and trial of off-the-shelf power wheelchairs. If standard devices are inadequate, the team prescribes a power operated vehicle K0812 with rationale for customization. Prior authorization may be obtained from payors (Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare) including mobility needs, seating/positioning requirements, and supplier quotes. Delivery includes device fitting, user training, and documentation of face-to-face encounter; follow-up visits address adjustments, repairs, and reassessment of capabilities.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when substantially greater work is required for special fabrication, complex fittings, or extensive device customization beyond usual services.

HCPCS K0861: Power Wheelchair Group 3 Standard, 300 lb Capacity

HCPCS-K0019-ARM-PAD-REPLACEMENT

HCPCS K0019: Arm Pad, Replacement Only, Each

HCPCS-K0828-POWER-WHEELCHAIR-EXTRA-HEAVY-DUTY-601-PLUS-LBS

HCPCS K0828: Power Wheelchair, Extra Heavy Duty, 601+ lb

HCPCS-K0821-POWER-WHEELCHAIR-GROUP-2-PORTABLE-CAPTAINS-CHAIR-300LB

HCPCS Level II K0821: Power Wheelchair Group 2 Portable, Captain's Chair

HCPCS-K0746-ABSORPTIVE-WOUND-DRESSING-HOME-NPWT-PAD-OVER-48-SQ-IN

HCPCS K0746: Absorptive Wound Dressing for Home NPWT, Pad >48 sq in

HCPCS-K0823-POWER-WHEELCHAIR-GROUP-2-CAPTAINS-CHAIR-300LB

HCPCS K0823: Power Wheelchair Group 2, Captain's Chair (≤300 lb)

HCPCS-K0829-POWER-WHEELCHAIR-EXTRA-HEAVY-DUTY-601-PLUS

HCPCS K0829: Power Wheelchair, Extra Heavy Duty, Captains Chair, 601+ lbs

HCPCS-K0840-POWER-WHEELCHAIR-EXTRA-HEAVY-DUTY-601LBS-PLUS

HCPCS K0840: Power Wheelchair, Extra Heavy Duty (601+ lb)

HCPCS-K0045-FOOTREST-COMPLETE-ASSEMBLY-REPLACEMENT

HCPCS Level II K0045: Footrest, Complete Assembly, Replacement

HCPCS-K0859-POWER-WHEELCHAIR-GROUP-3-HEAVY-DUTY-301-450-LB

HCPCS K0859: Power Wheelchair, Group 3 Heavy Duty, 301–450 lb

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Taxonomy Code	Specialty	Notes
`2084P0800X`	Physical Medicine & Rehabilitation Physician	Evaluates functional mobility, documents medical necessity, oversees device selection.
`2086S0102X`	Physical Therapist	Performs mobility assessment, trial seating, and functional testing for device prescription.
`334800000X`	Occupational Therapist	Assesses activities of daily living, control interfaces, and environmental needs.
`331G00000X`	Durable Medical Equipment Supplier	Provides device fitting, customization, delivery, and training.
`208D00000X`	Prosthetist/Orthotist	Provides seating systems, custom interfaces, and component fabrication when required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G82.20`	Paraplegia, unspecified	Mobility impairment often necessitating a power operated vehicle for community ambulation.
`G81.90`	Hemiplegia, unspecified affecting unspecified side	Post-stroke hemiplegia with impaired ambulation and balance indicating need for powered mobility.
`G35`	Multiple sclerosis	Progressive weakness and fatigue leading to inability to ambulate safely without power assist.
`Z89.611`	Acquired absence of right leg below knee	Lower-limb amputation with limited ambulation options; powered vehicle may restore independence.
`M16.11`	Unilateral primary osteoarthritis, right hip	Severe joint disease resulting in inability to propel manual wheelchair; power vehicle considered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97161`	Physical therapy evaluation, low complexity	Performed at initial assessment to document mobility deficits and goals prior to ordering `K0812`.
`97162`	Physical therapy evaluation, moderate complexity	Used when the evaluation documents multiple comorbidities and moderate assessment complexity for device justification.
`97530`	Therapeutic activities, direct (one-on-one)	Therapy sessions training patient in transfers, wheelchair propulsion, and community mobility after delivery.
`97760`	Orthotic and prosthetic management and training, initial encounter	Used when training on operation and maintenance of a power operated vehicle is provided by a therapist or orthotist.
`99070`	Supplies and materials (except spectacles), provided by the physician	Used for additional small supplies or accessories provided during fitting or training sessions.

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