Summary & Overview
HCPCS K0826: Power Wheelchair, Very Heavy Duty 451–600 lb
HCPCS Level II code K0826 designates a very heavy-duty power wheelchair with a sling or solid seat/back and a patient weight capacity of 451 to 600 pounds. This equipment classification is significant for ensuring appropriate mobility solutions for patients with high body weight who require durable power mobility devices. Nationally, coverage and payment for this device affect access to mobility, patient safety, and durable medical equipment supply chains.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and device characteristics, payer coverage patterns and benchmarks where available, common billing considerations, and recent policy or coding updates that influence reimbursement and documentation standards. The publication also outlines typical sites of service and scenarios where K0826 is the applicable billing code.
This summary provides context for clinicians, DME suppliers, and billing professionals seeking clarity on classification, payer considerations, and operational implications for high-capacity power wheelchairs.
Billing Code Overview
HCPCS Level II code K0826 describes a power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds. This device is a durable medical equipment mobility aid intended for patients requiring a very heavy-duty power wheelchair with a high weight capacity.
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Service type: Durable medical equipment — power mobility device
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Typical site of service: Durable medical equipment supplier, home use, long-term care facilities
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Clinical & Coding Specifications
Clinical Context
A 52-year-old male patient with morbid obesity (body weight 480 pounds) and severe bilateral knee osteoarthritis presents to a durable medical equipment (DME) supplier after evaluation by a physiatrist. The patient ambulates only short distances with a walker and reports progressive functional decline, frequent falls, and inability to perform activities of daily living safely at home. The physiatrist documents medical necessity for a power wheelchair with very heavy duty capacity due to the patient’s body habitus and comorbid mobility-limiting conditions. The DME supplier arranges a face-to-face or telehealth functional assessment, documents seat dimensions and weight capacity requirements, selects a Group 2 very heavy duty power wheelchair with sling/solid seat/back rated for 451–600 pounds, and obtains prior authorization from payors. The workflow includes ordering by the treating physician, supplier fitting and measurement, delivery with patient training, documentation of trial mobility (if required by payor), and billing with HCPCS code K0826 plus applicable modifiers and supporting ICD-10 diagnosis codes for obesity, osteoarthritis, or neuromuscular impairment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
KA | Data not available in the input. | Data not available in the input. |