Summary & Overview
HCPCS K0838: Power Wheelchair, Heavy Duty, 301–450 lb
HCPCS Level II code K0838 identifies a heavy-duty group 2 power wheelchair with a single power option and a captain's chair designed for patients with weight capacity between 301 and 450 pounds. This durable medical equipment code matters nationally because it defines coverage and billing for higher-capacity mobility devices used by adults with mobility impairments, impacting access to appropriate assistive technology and the cost of long-term mobility care.
Key payers included in this review are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what K0838 represents, typical sites of service, and which payers are commonly involved in coverage. The publication summarizes benchmarks and policy context relevant to billing and reimbursement for heavy-duty power wheelchairs, highlights common clinical scenarios that drive device selection, and outlines areas where policy updates or prior authorization requirements typically affect utilization. Data not available in the input is noted where applicable. This resource is intended to inform clinicians, billing staff, and policy analysts about the clinical and administrative significance of HCPCS Level II code K0838.
Billing Code Overview
HCPCS Level II code K0838 describes a power wheelchair, group 2 heavy duty, single power option, captain's chair, patient weight capacity 301 to 450 pounds. This item is a durable medical equipment mobility device intended for individuals who require a heavy-duty powered wheelchair with a single power option and enhanced seating in the form of a captain's chair.
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Service type: Durable medical equipment (power mobility device)
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Typical site of service: Outpatient, home, or community settings where durable medical equipment is supplied and used such as patient residences and ambulatory durable medical equipment providers.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with morbid obesity (body weight 340 pounds), peripheral neuropathy from long-standing type 2 diabetes mellitus, and severe osteoarthritis of both knees has persistent mobility limitations despite outpatient physical therapy and a trial of a standard manual wheelchair. The patient’s primary care physician documents inability to ambulate safely in the community, frequent falls during transfers, and inability to propel a manual wheelchair due to upper extremity weakness and deconditioning. A durable medical equipment (DME) evaluation by a licensed clinician and a supplier assessment recommends a power wheelchair, group 2 heavy duty, single power option with a captain’s chair and a patient weight capacity of 301–450 pounds to provide safe seated posture, pressure distribution, and independence in community ambulation. The clinical workflow includes: face-to-face evaluation and documentation of functional limitations and home environment; trial of less complex mobility devices as clinically appropriate; completion of medical necessity documentation and mobility assessment form; prior authorization submission to the patient’s payor; delivery and in-home setup by the DME supplier; and training by a qualified clinician on safe operation and transfers. Typical site of service is the patient’s home with outpatient assessments occurring in a clinic or home health setting.
Coding Specifications
| Modifier | Description | When to Use |
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KS is not in the provided list; see selected applicable modifiers below |