K0849 Power Wheelchair HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS K0849: Power Wheelchair, Group 3 Captain's Chair, ≤300 lb

HCPCS Level II code K0849 denotes a Group 3 standard power wheelchair with a captain’s chair and a patient weight capacity up to and including 300 pounds. As a durable medical equipment (DME) item, this code is relevant for mobility-impaired patients who require powered seating and propulsion for community and home use. Nationally, powered mobility devices are a focal point for DME benefit management, utilization review, and policy guidance because of cost, clinical appropriateness, and safety considerations.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage and billing contexts for K0849, typical sites of service, and common clinical scenarios that justify use. The publication summarizes benchmark considerations, documentation and prior authorization themes, and areas where policy updates frequently arise for Group 3 power wheelchairs.

This summary provides a concise reference for billing, coding, and reimbursement professionals, DME suppliers, and clinicians involved in mobility assessments. Data not available in the input will be noted where applicable in detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0849HCPCS Level IIpower wheelchairdurable medical equipmentGroup 3 wheelchaircaptain's chairmobility device

Billing Code Overview

HCPCS Level II code K0849 describes a power wheelchair, Group 3 standard, captain's chair, patient weight capacity up to and including 300 pounds. This item represents a power mobility device intended for patients who require a motorized wheelchair for daily mobility and seating support.

Service type: Durable medical equipment (power mobility device)
Typical site of service: Home or other community settings where a power wheelchair is used for personal mobility and activities of daily living.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with progressive mobility impairment from advanced osteoarthritis and decreased endurance presents to a durable medical equipment (DME) supplier after functional assessment by a physical therapist. The patient requires permanent, full-time mobility assistance and cannot safely ambulate or perform activities of daily living with a cane or manual wheelchair. The clinician documents a face-to-face evaluation noting limited standing tolerance, impaired balance, decreased walking distance, and need for a power mobility device. A prescription is written for a power wheelchair, group 3 standard with captain's chair, weight capacity up to and including 300 pounds (K0849).

The clinical workflow includes: initial physician or qualified practitioner evaluation and documentation of mobility deficits and comorbidities; a physical therapy or occupational therapy mobility assessment including standardized driving and transfers tests; selection of appropriate seating and controls; prior authorization submission to the patient’s payor with medical necessity justification and supporting documentation (face-to-face notes, assessments, and prescription); delivery and fitting by DME supplier; training on safe operation and transfer techniques; and post-delivery follow-up to confirm function and continued medical necessity.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)

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

HCPCS-K0806-POWER-OPERATED-VEHICLE-GROUP-2-STANDARD-300-LB-CAPACITY

HCPCS K0806: Power Operated Vehicle, Group 2 Standard (≤300 lb)

HCPCS-K0814-POWER-WHEELCHAIR-GROUP-1-PORTABLE-CAPTAINS-CHAIR-300LBS

HCPCS K0814: Power Wheelchair, Group 1 Portable Captain's Chair 300 lb

HCPCS-K0010-STANDARD-WEIGHT-FRAME-POWER-WHEELCHAIR

HCPCS K0010: Standard Weight Frame Motorized/Power Wheelchair

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-K0830-POWER-WHEELCHAIR-GROUP-2-SEAT-ELEVATOR-300LB

HCPCS K0830: Power Wheelchair Group 2 with Seat Elevator, ≤300 lb

HCPCS-K0877-POWER-WHEELCHAIR-GROUP-4-STANDARD-300LB-CAPACITY

HCPCS Level II K0877: Power Wheelchair Group 4 Standard, 300 lb Capacity

HCPCS-K0733-POWER-WHEELCHAIR-12-24AH-SEALED-LEAD-ACID-BATTERY

HCPCS Level II K0733: Power Wheelchair 12–24 Ah Sealed Lead Acid Battery

HCPCS-K0815-POWER-WHEELCHAIR-GROUP1-SLING-SEAT-UP-TO-300LBS

HCPCS K0815: Power Wheelchair Group 1, Sling/Solid Seat, ≤300 lb

HCPCS-K0837-POWER-WHEELCHAIR-GROUP-2-HEAVY-DUTY-301-450-LB

HCPCS K0837: Heavy-Duty Power Wheelchair, 301–450 lb

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Taxonomy Code	Specialty	Notes
`261QM0800X`	Physical Therapist	Performs mobility and functional assessments driving device selection.
`261QP2300X`	Occupational Therapist	Evaluates transfers, seating and activities of daily living for device configuration.
`332B00000X`	Durable Medical Equipment Supplier	Provides device selection, delivery, and fitting services.
`207QA0000X`	Family Medicine Physician	Documents face-to-face evaluation and writes prescription for DME.
`208D00000X`	Orthopedic Surgeon	Evaluates surgical factors affecting mobility and device candidacy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M16.11`	Unilateral primary osteoarthritis, right hip	Weight-bearing joint degeneration causing mobility limitation and power mobility need.
`M17.11`	Unilateral primary osteoarthritis, right knee	Knee osteoarthritis limiting ambulation endurance and safe mobility.
`G82.50`	Paraplegia, unspecified	Neurologic paralysis resulting in need for full-time powered mobility.
`G20`	Parkinson disease	Progressive gait impairment, postural instability, and falls risk necessitating power wheelchair.
`R26.2`	Difficulty in walking, not elsewhere classified	Functional gait impairment commonly used to justify mobility devices.
`I69.351`	Hemiplegia and hemiparesis following cerebral infarction, right dominant side	Post-stroke motor deficits causing inability to ambulate safely; supports power mobility.
`M48.02`	Spinal stenosis, thoracic region	Neurogenic claudication and gait disturbance contributing to need for powered wheelchair.
`R53.1`	Weakness	Generalized weakness as a clinical rationale for power mobility device.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97161`	Physical therapy evaluation, low complexity	Used for initial PT evaluation documenting mobility limitations supporting power wheelchair prescription.
`97162`	Physical therapy evaluation, moderate complexity	Used when multiple comorbidities and moderate complexity assessment justify device need.
`97163`	Physical therapy evaluation, high complexity	Used for comprehensive mobility evaluations with complex decision-making for group 3 power wheelchair.
`97001`	Physical therapy evaluation (historic CPT, may be used in some payor forms)	Older code sometimes referenced in DME justification forms for baseline functional assessment.
`97760`	Orthotic(s)/prosthetic(s) management and training, initial	Used when training is provided for device use, transfers, and wheelchair management at delivery.
`99070`	Supplies and materials (e.g., devices)	Used by providers when billing for non-covered supplies associated with fitting and training.

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