Summary & Overview
HCPCS K0813: Power Wheelchair, Group 1 Standard Portable, 300 lb Capacity
HCPCS Level II code K0813 represents a Group 1 standard, portable power wheelchair with a sling or solid seat and back and a patient weight capacity up to and including 300 pounds. This code identifies a common category of durable medical equipment used to restore mobility for individuals with mobility-limiting conditions. Nationally, accurate coding of power wheelchairs like K0813 matters for durable medical equipment coverage determinations, medical necessity reviews, and appropriate payment across public and private payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for power wheelchairs, typical sites of service, and the service type. The publication outlines benchmarking expectations and payment considerations, common policy themes that influence coverage decisions, and operational points for billing and documentation. Where specific payer policy details or benchmarks are not available in the input, the publication notes that data are not available in the input.
This summary is written for a national audience and focuses on the role of K0813 in durable medical equipment workflows, payer coverage patterns, and the clinical scenarios that drive use of a portable power wheelchair with a 300-pound capacity.
Billing Code Overview
HCPCS Level II code K0813 describes a power wheelchair, group 1 standard, portable, sling/solid seat and back designed for a patient weight capacity up to and including 300 pounds. The code covers a standard-weight, portable power wheelchair intended for mobility assistance for patients who meet clinical need criteria for a powered mobility device.
Service type: Durable medical equipment — power wheelchair
Typical site of service: Home or community settings (durable medical equipment furnished for use by a patient outside a facility)
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with mobility impairment due to neurological or musculoskeletal disease who requires a portable power wheelchair with a sling or solid seat and back and a weight capacity up to 300 pounds. Example: a 68-year-old patient with post-stroke hemiparesis and limited endurance uses a portable Group 1 power wheelchair for community ambulation and household mobility. The clinical workflow begins with a referring clinician (primary care physician, physiatrist, or neurologist) documenting functional limitations, a face-to-face mobility evaluation by a qualified clinician or ATP (Assistive Technology Professional), measurement of seat dimensions and weight capacity needs, assessment of home and community access, and trialing of the portable power wheelchair. Documentation includes the patient’s diagnosis, objective functional deficits (gait distance, transfers, upper extremity strength), a detailed mobility goals statement, justification for power mobility versus manual wheelchair, and specification of the K0813 device features (portable, sling/solid seat and back, Group 1 standard, capacity ≤300 lb). The durable medical equipment supplier verifies configuration, delivers the device, provides training, and documents medical necessity, device settings, and patient competency. Follow-up includes adjustment visits and maintenance documentation as clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default / No modifier |