Summary & Overview
HCPCS K0820: Power Wheelchair Group 2 Portable, Up to 300 lb
HCPCS Level II code K0820 identifies a portable group 2 power wheelchair with a sling or solid seat/back and a patient weight capacity up to and including 300 pounds. This code covers a commonly used class of durable medical equipment that supports mobility and independence for patients with mobility impairments. Its correct use affects coverage decisions, supplier billing, and beneficiary access to appropriate mobility devices nationwide.
The analysis covers key national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage patterns and payer considerations, typical sites of service for provision and delivery, and the clinical context for selecting a portable group 2 power wheelchair. The publication also highlights benchmarks and policy updates relevant to durable medical equipment billing and documentation standards.
Intended for clinicians, DME suppliers, billing professionals, and policy analysts, the content explains the code definition, typical use cases, and what billing and documentation elements are commonly relevant for coverage adjudication. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code K0820 describes a power wheelchair, group 2 standard, portable, with a sling/solid seat and back, and a patient weight capacity up to and including 300 pounds. The service represented is the provision and delivery of a portable group 2 power wheelchair intended for mobility assistance for individuals whose weight does not exceed 300 pounds.
Service type: Durable Medical Equipment (power wheelchair), mobility device provision and delivery
Typical site of service: Outpatient settings, durable medical equipment suppliers, patient homes, and other community settings where mobility devices are provided and set up
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with advanced osteoarthritis of both knees and limited endurance presents to an outpatient durable medical equipment (DME) supplier after evaluation by his primary care physician and physical therapist. The patient is functionally unable to ambulate long distances due to pain, deconditioning, and risk of falls. He uses a cane at home but requires a mobility device for community ambulation to attend medical appointments and grocery shopping. The treating physician documents medical necessity, including history, physical exam, prior conservative interventions (assistive devices trial, physical therapy), and a mobility assessment demonstrating inability to perform activities of daily living safely without a powered mobility device.
The DME supplier orders a power wheelchair billed under K0820 — a Group 2 standard portable power wheelchair with a sling/solid seat/back and patient weight capacity up to and including 300 pounds. Typical workflow includes physician face-to-face evaluation and written order, mobility evaluation and justification by a therapist or certified ATP/occ. therapist, prior authorization if required by the payer, delivery and patient training by the supplier, and documentation of device setup and patient competency. Typical site of service is outpatient DME supplier or patient home for delivery and training. Payers that may be involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA (block utility commercial administrators), and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 |