Summary & Overview
HCPCS K0851: Power Wheelchair, Heavy-Duty Captain's Chair (301–450 lb)
HCPCS Level II code K0851 designates a group 3 heavy-duty power wheelchair with a captain's chair and patient weight capacity of 301 to 450 pounds. As a classification for high-capacity power mobility devices, this code matters nationally because it guides coverage determinations, prior authorization processes, and supplier billing for patients who need greater weight capacity and heavy-duty components. Payors commonly involved in coverage decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what this code represents clinically and operationally, how it fits within durable medical equipment and mobility device categories, and which payors are typically relevant in coverage discussions. The publication provides benchmarks and policy context where available, outlines common billing considerations and modifiers associated with durable medical equipment billing, and summarizes typical sites of service and clinical contexts for use. Data not available in the input is explicitly noted where applicable. The focus is national: clinical purpose, payer engagement, and administrative context for K0851 to inform clinicians, billing professionals, and policy analysts.
Billing Code Overview
HCPCS Level II code K0851 describes a power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds. This item is a durable medical equipment mobility device intended for patients requiring a heavy-duty, high-capacity power wheelchair.
-
Service type: Durable medical equipment (power mobility device)
-
Typical site of service: Home or community settings where durable medical equipment is used for patient mobility support
Clinical & Coding Specifications
Clinical Context
A 62-year-old male patient with morbid obesity and advanced osteoarthritis of both knees requires a durable power wheelchair with increased weight capacity. The patient is unable to ambulate household distances safely due to pain and deconditioning, and uses a bariatric power wheelchair for community mobility and activities of daily living. Supply coordination begins with a referring physician (often a physiatrist or primary care physician) documenting medical necessity for a power wheelchair capturing mobility limitations, functional goals, weight capacity requirement, and previous mobility aids tried. A durable medical equipment provider conducts an in-person or telehealth wheelchair evaluation, measures the patient, selects a Group 3 heavy-duty power wheelchair with a captain's chair and 301–450 pound capacity (K0851), configures seating and controls, documents the chosen options, and submits the prior authorization and claim to the patient’s payer. Delivery includes patient training, seating adjustments, and documentation of the final setup. Follow-up addresses maintenance, repairs, and reassessment of mobility needs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Rare for DME; used if a separately billable professional component (e.g., evaluation) is billed by a clinician. |