Summary & Overview
HCPCS K0815: Power Wheelchair Group 1, Sling/Solid Seat, ≤300 lb
HCPCS Level II code K0815 identifies a Group 1 standard power wheelchair with a sling or solid seat and back and a patient weight capacity up to and including 300 pounds. This code matters nationally because power wheelchairs are commonly prescribed durable medical equipment that affect patient independence, long-term care needs, and durable medical equipment spending across public and private payers. Coverage, prior authorization, and billing practices for power mobility devices vary across major payers, making consistent code interpretation important for suppliers, clinicians, and 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 K0815, typical sites of service, and the role of this equipment in mobility support. The publication provides benchmarks and policy context where available, highlights common billing and documentation considerations, and summarizes payer-specific coverage tendencies. Data not available in the input is noted where applicable. The goal is to give a concise reference for coding and payer navigation at a national level without providing clinical recommendations.
Billing Code Overview
HCPCS Level II code K0815 describes a power wheelchair, Group 1 standard, with a sling/solid seat and back, and a patient weight capacity up to and including 300 pounds. This item is durable medical equipment intended to provide mobility assistance for patients who require a powered mobility device.
Service Type: Power wheelchair supply (durable medical equipment)
Typical Site of Service: Home, community, or outpatient settings where durable medical equipment is delivered and used for activities of daily living.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with advanced Parkinson disease and significant gait instability presents to durable medical equipment (DME) services after multiple falls and progressive inability to propel a manual wheelchair. The patient has sufficient upper extremity function impairment and decreased endurance such that activities of daily living (transfers, toileting, shopping) are unsafe without a mobility device. A physiatrist or occupational therapist performs an evaluation, documents medical necessity, functional limitations, home environment assessment, and a trial of a standard power wheelchair. The DME supplier completes device selection, verifies weight capacity requirements (patient weight ≤ 300 pounds), documents seating needs (sling/solid seat and back), obtains prior authorization from the payer, and arranges delivery, training, and follow-up maintenance. Typical sites of service include outpatient rehabilitation clinics, DME supplier offices, the patient’s home for delivery and setup, and occasionally inpatient rehabilitation units during discharge planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Rarely used; avoid unless payer requires an unspecified modifier |
22 | Increased procedural services |