K0828 Power Wheelchair (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS K0828: Power Wheelchair, Extra Heavy Duty, 601+ lb

HCPCS Level II code K0828 denotes a power wheelchair, group 2 extra heavy duty, with a sling or solid seat/back and a patient weight capacity of 601 pounds or more. This code identifies high-capacity mobility equipment intended for patients with extreme body weight or specific clinical needs requiring reinforced frames and seating systems. Nationally, accurate use of K0828 matters for appropriate access to necessary mobility aids, proper documentation of clinical necessity, and accurate claims processing for specialized durable medical equipment.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the code is categorized, typical sites of service, and the clinical context for prescribing and billing such high-capacity power wheelchairs. The publication summarizes common payer considerations, coding nuances, and relevant billing modifiers (listed separately), and highlights benchmarks and policy updates where available.

This report is intended to inform clinicians, medical billers, suppliers, and policy stakeholders about the clinical description and billing classification of K0828, the typical settings where services occur, and the payer landscape nationally. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0828HCPCS Level IIpower wheelchairdurable medical equipmentmobility deviceextra heavy dutywheelchair codingDME billingpatient weight capacitymedical equipment policy

Billing Code Overview

HCPCS Level II code K0828 describes a power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more. This item is a durable medical equipment mobility device designed for patients who require a motorized wheelchair with an extra-heavy-duty frame and seating system to support very high weight capacities.

Service type: Durable medical equipment (power wheelchair)
Typical site of service: Durable medical equipment supplier, patient home, or other community setting where mobility devices are used

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with morbid obesity (body weight 680 pounds) and end-stage osteoarthritis of both knees presents to durable medical equipment (DME) services for evaluation of mobility needs. He is non-ambulatory at home, requires a power mobility device for transfers and community access, and has persistent pain limiting standing tolerance. The DME clinical workflow includes: a physician or qualified healthcare professional documents medical necessity and functional mobility assessment; completion of a detailed prescription specifying K0828 (power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more); verification of patient weight and dimensions; selection of appropriate seat and controls by a rehabilitation therapist or DME specialist; prior authorization submission to the payer with supporting documentation (office notes, signed face-to-face or telehealth evaluation, need for powered mobility for mobility limitation); delivery, setup, and patient training; and follow-up for device fit, pressure-relief needs, and any necessary adjustments or repairs. Typical sites of service include outpatient DME supplier locations, rehabilitation clinics, home health settings for delivery and training, and inpatient settings when discharge planning requires provision of a bariatric power wheelchair.

Coding Specifications

Modifier	Description	When to Use
`KA`	Data not available in the input.

Related Codes

HCPCS-K0037-HIGH-MOUNT-FLIP-UP-FOOTREST

HCPCS K0037: High Mount Flip-Up Footrest, Each

HCPCS-K0552-SYRINGE-CARTRIDGE-EXTERNAL-DRUG-INFUSION-PUMP

HCPCS K0552: Syringe-Type Cartridge for External Non-Insulin Infusion Pump

HCPCS-K0870-POWER-WHEELCHAIR-HEAVY-DUTY-301-450-LB-CAPACITY

HCPCS K0870: Power Wheelchair, Heavy Duty, 301–450 lb

HCPCS-K0609-AED-GARMENT-REPLACEMENT-ELECTRODES

HCPCS K0609: Replacement Electrodes for Garment-Type AEDs

HCPCS-K0841-POWER-WHEELCHAIR-GROUP-2-STANDARD-300-LB-CAPACITY

HCPCS K0841: Power Wheelchair Group 2 Standard, 300 lb Capacity

HCPCS-K0020-FIXED-ADJUSTABLE-HEIGHT-ARMREST-PAIR

HCPCS K0020: Fixed, Adjustable Height Armrest, Pair

HCPCS-K0554-THERAPEUTIC-GLUCOSE-CONTINUOUS-MONITOR-RECEIVER

HCPCS K0554: Receiver for Therapeutic Continuous Glucose Monitor

HCPCS-K0820-POWER-WHEELCHAIR-GROUP-2-PORTABLE-300LB-CAPACITY

HCPCS K0820: Power Wheelchair Group 2 Portable, Up to 300 lb

HCPCS-K0808-POWER-OPERATED-VEHICLE-VERY-HEAVY-DUTY-451-600-LB

HCPCS K0808: Power Operated Vehicle, Very Heavy Duty (451–600 lb)

HCPCS-K0005-ULTRALIGHTWEIGHT-WHEELCHAIR

HCPCS K0005: Ultralightweight Wheelchair

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Taxonomy Code	Specialty	Notes
`3336P0800X`	Physical Medicine & Rehabilitation Physician	Physicians who document medical necessity and functional evaluation for mobility devices.
`251B00000X`	Physical Therapist	Performs mobility assessments, seating evaluations, and recommends wheelchair configurations.
`3336A0200X`	Occupational Therapist	Conducts activities of daily living and seating assessments for device prescription.
`331K00000X`	Durable Medical Equipment Supplier	DME suppliers provide device selection, delivery, setup, and training.
`163W00000X`	Home Health Agency (Facility)	Provides in-home delivery and training when services occur in the home setting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E66.01`	Morbid (severe) obesity due to excess calories	High body weight requiring extra heavy duty bariatric power wheelchair like `K0828`.
`M17.11`	Unilateral primary osteoarthritis, right knee	Severe knee osteoarthritis limiting ambulation and necessitating powered mobility.
`M17.12`	Unilateral primary osteoarthritis, left knee	Same as above for the contralateral knee when bilateral disease restricts walking.
`G81.90`	Hemiplegia, unspecified affecting unspecified side	Neurologic weakness causing limited mobility and need for powered mobility device.
`G82.50`	Paraplegia, unspecified	Paralysis of lower extremities often necessitating power wheelchair with high weight capacity.
`R26.2`	Difficulty in walking, not elsewhere classified	Functional gait impairment supporting medical necessity for power mobility.
`Z99.3`	Dependence on wheelchair	Ongoing dependence that supports provision of a bariatric power wheelchair.
`M62.81`	Muscle weakness (generalized)	Weakness limiting safe ambulation and transfers, indicating need for powered mobility.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97535`	Self-care/home management training (e.g., activities of daily living and compensatory training) direct one-on-one patient, each 15 minutes.	Occupational therapy sessions to train the patient in power wheelchair use and ADL adaptations prior to or after device delivery.
`97112`	Therapeutic procedure; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for each 15 minutes.	Physical therapy interventions to improve safe use of a power wheelchair and transfers.
`97755`	Assistive technology assessment; each 15 minutes.	Comprehensive assessment and documentation of device needs, including seating and mobility evaluations supporting `K0828` prescription.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes.	Physician visit to document medical necessity and sign the prescription for a power wheelchair.
`99456`	Work-related or medical disability examination services.	Occasionally used when disability evaluation documentation is required to support mobility device necessity.