K0816 Power Wheelchair | HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS K0816: Power Wheelchair Group 1, Captain's Chair, up to 300 lb

HCPCS Level II code K0816 designates a group 1 standard power wheelchair with a captain's chair and a patient weight capacity up to and including 300 pounds. This code identifies a category of durable medical equipment used to support mobility for patients who require powered wheelchairs due to functional limitation. Nationally, such codes matter because they drive coverage decisions, supplier billing, and clinical decision-making around durable medical equipment allocation.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage considerations and where K0816 fits in clinical and billing workflows, along with benchmarks and policy context relevant to durable medical equipment and mobility devices. The publication outlines reimbursement and utilization benchmarks, typical sites of service for delivery and assessment, and recent policy developments affecting power wheelchair coverage and documentation requirements.

The report is intended to help billing managers, DME suppliers, clinical staff, and policy analysts understand the classification and common use cases for HCPCS Level II code K0816, and to summarize the payer landscape and policy factors that influence access to power mobility devices.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0816HCPCS Level IIpower wheelchairdurable medical equipmentmobility devicehome healthcaptains chairweight capacityDME billing

Billing Code Overview

HCPCS Level II code K0816 describes a power wheelchair, group 1 standard, captain's chair with a patient weight capacity up to and including 300 pounds. The product category is a durable medical equipment mobility device intended to provide powered ambulatory assistance for patients with mobility impairments.

Service type: Durable medical equipment (power mobility device)
Typical site of service: Durable medical equipment suppliers, home use, and outpatient settings where power mobility is initiated or evaluated

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with mobility impairment due to progressive neuromuscular disease, spinal cord injury, severe osteoarthritis, or stroke-related hemiparesis who requires a power wheelchair for community and home mobility. The device described by K0816 is a Group 1 standard power wheelchair with a captain’s chair and a patient weight capacity up to and including 300 pounds. Clinical workflow begins with a physician or qualified practitioner evaluation documenting functional limitations (ambulation distance, transfers, endurance, and safety), home and community access needs, and prior use of mobility aids. A physical or occupational therapist performs a mobility assessment including seating, postural support needs, and environmental barriers. Documentation includes medical necessity, trial use or demonstration of a power wheelchair when applicable, detailed measurements for seating and positioning, and a written order specifying K0816 or equivalent description. The supplier verifies payer coverage, delivers the device, provides patient and caregiver training, and documents setup, adjustments, and follow-up assessments. Typical sites of service are outpatient durable medical equipment suppliers, home, inpatient rehabilitation facilities, and outpatient therapy clinics where assessments and training occur.

Coding Specifications

Modifier	Description	When to Use
`00`

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

HCPCS-K0745-ABSORPTIVE-WOUND-DRESSING-PORTABLE-HOME-NPWT-16-48-SQIN

HCPCS K0745: Absorptive Wound Dressing for Portable Home Suction Pump

HCPCS-K0862-POWER-WHEELCHAIR-GROUP-3-HEAVY-DUTY-301-450-LB-CAPACITY

HCPCS K0862: Power Wheelchair, Group 3 Heavy Duty, 301–450 lb Capacity

HCPCS-K0851-POWER-WHEELCHAIR-HEAVY-DUTY-CAPTAINS-CHAIR-301-450-LBS

HCPCS K0851: Power Wheelchair, Heavy-Duty Captain's Chair (301–450 lb)

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

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

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

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

HCPCS-K0822-POWER-WHEELCHAIR-GROUP-2-STANDARD-UP-TO-300LBS

HCPCS K0822: Power Wheelchair Group 2, Sling/Solid Seat, Up to 300 lbs

HCPCS-K0044-FOOTREST-UPPER-HANGER-BRACKET-REPLACEMENT

HCPCS K0044: Footrest Upper Hanger Bracket Replacement, Each

HCPCS-K0052-SWINGAWAY-DETACHABLE-FOOTRESTS-REPLACEMENT

HCPCS K0052: Swingaway Detachable Footrests, Replacement Only, Each

HCPCS-K0006-HEAVY-DUTY-WHEELCHAIR

HCPCS Level II K0006: Heavy Duty Wheelchair

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Taxonomy Code	Specialty	Notes
`225100000X`	Physical Therapist	Performs mobility and seating assessments; documents functional limitations and training.
`225200000X`	Occupational Therapist	Conducts activities-of-daily-living assessment and seating/positioning recommendations.
`208000000X`	Physical Medicine & Rehabilitation Physician	Provides medical necessity certification and oversight for complex mobility devices.
`207Q00000X`	Family Medicine Physician	Initiates DME orders for chronic mobility-limiting conditions and coordinates care.
`207L00000X`	Internal Medicine Physician	Manages chronic diseases leading to mobility impairment and documents need for DME.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G82.20`	Paraplegia, unspecified	Patients with paraplegia often require power wheelchairs for community mobility and independence.
`G82.50`	Quadriplegia, unspecified	Quadriplegic patients frequently need power wheelchairs with appropriate seating and control options.
`G12.21`	Amyotrophic lateral sclerosis	Progressive motor neuron disease leading to loss of ambulation and need for power mobility.
`I69.391`	Hemiplegia and hemiparesis following cerebral infarction, right dominant side	Post-stroke hemiparesis often results in decreased ambulation and need for power mobility.
`M19.90`	Osteoarthritis, unspecified site	Severe degenerative joint disease can limit ambulation making a power wheelchair clinically appropriate.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97161`	Physical therapy evaluation, low complexity	Used when a PT evaluates the patient’s mobility needs prior to power wheelchair selection; documents functional limitations.
`97162`	Physical therapy evaluation, moderate complexity	Used when the evaluation requires moderate clinical decision-making for seating or power wheelchair prescription.
`97163`	Physical therapy evaluation, high complexity	Used for complex patients requiring detailed assessment and customized seating plans before ordering `K0816`.
`97530`	Therapeutic activities, direct (one-on-one), each 15 minutes	Used for training the patient in transfers, propulsion, and use of the power wheelchair during occupational or physical therapy sessions.
`97542`	Wheelchair management (e.g., assessment, fitting, training)	Directly related to assessment, fitting, and training associated with delivery of a power wheelchair coded as `K0816`.
`99070`	Supplies and materials (eg, nonphysician purchased)	Used when billing for additional disposable supplies or noncapital accessories provided with the device, as allowed by payer.

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