Summary & Overview

HCPCS K0852: Power Wheelchair, Very Heavy Duty (451–600 lbs)

HCPCS Level II code K0852 denotes a very heavy-duty group 3 power wheelchair with a sling or solid seat/back and a patient weight capacity of 451 to 600 pounds. This code identifies high-capacity mobility equipment used for patients with substantial weight and mobility needs and is relevant for national coverage, supplier provisioning, and durable medical equipment (DME) management. Its classification as group 3 reflects a higher specification and typical power-assist features to accommodate greater loads.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, typical sites of service, and payer relevance. The publication outlines common billing considerations, expected documentation themes, and where this equipment fits in clinical care pathways for mobility-impaired patients.

This analysis equips DME suppliers, clinicians, and policy stakeholders with benchmarks on coding definitions, payer coverage contexts, and operational implications for dispensing and servicing very heavy-duty power wheelchairs. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0852HCPCS Level IIpower wheelchairdurable medical equipmentmobilitywheelchair seatinggroup 3

Billing Code Overview

HCPCS Level II code K0852 describes a power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds. This item is a durable medical equipment mobility device intended for patients who require a very heavy-duty power wheelchair due to higher body weight or greater functional needs.

Service type: Durable medical equipment — power wheelchair
Typical site of service: Durable medical equipment supplier, patient's home, or other community settings where a personal mobility device is used

Clinical & Coding Specifications

Clinical Context

A 58-year-old male patient with morbid obesity (body weight 520 pounds), lumbar degenerative disease with chronic neuropathic pain, and limited ambulation due to severe osteoarthritis presents for durable medical equipment assessment. The patient lives at home with caregiver support and requires a power wheelchair with a high weight capacity for safe mobility and pressure distribution. A rehabilitation physician or durable medical equipment (DME) supplier performs an evaluation including mobility assessment, measurement of seat width/depth, functional transfer ability, and documentation of prior mobility aids and why they failed. The clinical workflow includes: a physician or qualified clinician documents medical necessity and functional limitations; an occupational therapist or physical therapist completes seating and positioning evaluation and recommends the specific configuration (sling/solid seat and back) and Group 3 very heavy duty frame; the DME supplier orders K0852 and coordinates delivery, seating setup, caregiver training, and a follow-up visit to verify function and fit. Common payors involved in authorization and coverage determination include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare. Documentation typically includes recent clinic notes, weight measurement, prior mobility aids, trial of alternatives, seating evaluation, and modifier usage as applicable for billing nuances.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When complexity of evaluation or customization (extensive seating modifications) substantially increases work beyond typical supply ordering.
`26`	Professional component	When a separately billable clinician professional component (e.g., physician evaluation) is reported distinct from DME supplier charges.
`52`	Reduced services	When a partial delivery or reduced scope of equipment occurs compared to ordered `K0852`.
`53`	Discontinued procedure	If the delivery or fitting is discontinued for patient safety before completion.
`54`	Surgical care only	Rare for DME; used if part of an associated surgical global period where supplier provided component only.
`55`	Postoperative management only	Similar to `54`, if follow-up DME services occur during a postoperative global period.
`62`	Two surgeons	Applied only if two qualified clinicians are documenting coordinated evaluations for complex seating and surgical interventions.
`78`	Unplanned return to the operating room	Not typical for DME; reserved when related surgical event occurs requiring additional DME adjustments billed separately.
`80`	Assistant surgeon	If an assistant documents a separate professional component relevant to mobility evaluation.
`82`	Assistant surgeon (when qualified resident surgeon unavailable)	As above when applicable.
`AS`	Accredited standards (used by some payors)	Applied per payer rules when accreditation or special assessment requirements are met for complex seating.
`RR`	Registered provider in respiratory therapy (payer-specific use)	Where supplier uses credentialed respiratory personnel for patients with comorbid respiratory equipment needs during mobility training.
`UE`	Left-sided procedure	Rarely used; only if payor requires laterality coding for adjunct procedures tied to wheelchair use.
`NU`	New equipment	Use when the item furnished is new rather than refurbished.

Taxonomy Code	Specialty	Notes
207Q00000X	Physical Medicine & Rehabilitation Physician	Conducts medical necessity evaluation and documents functional limitations.
3336C0002X	Occupational Therapist	Performs seating/positioning assessment and recommends cushion/seat configuration.
223Z00000X	Durable Medical Equipment Supplier	Orders, configures, furnishes, and trains on `K0852`.
231H00000X	Physical Therapist	Complements mobility assessment and functional mobility training.
2083P0800X	General Practice / Family Medicine	May document primary diagnosis and coordinate DME referral.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E66.01`	Morbid (severe) obesity due to excess calories	High body weight necessitating a very heavy duty power wheelchair with 451–600 lb capacity.
`M16.11`	Unilateral primary osteoarthritis, right hip	Severe lower-extremity joint disease limiting ambulation and indicating mobility device need.
`M17.11`	Unilateral primary osteoarthritis, right knee	Knee osteoarthritis causing gait instability and need for power mobility.
`G60.3`	Hereditary motor and sensory neuropathy	Neuropathy resulting in poor ambulation and need for powered seating support.
`G81.90`	Hemiplegia, unspecified affecting unspecified side	Neurologic impairment causing mobility deficit requiring a power wheelchair.
`R26.2`	Difficulty in walking, not elsewhere classified	Functional gait impairment often used to support DME necessity.
`Z99.11`	Dependence on wheelchair	Status code documenting ongoing need for wheelchair for mobility.
`M48.06`	Spinal stenosis, lumbar region	Neurogenic claudication and limited ambulation supporting power wheelchair provision.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97162`	Physical therapy evaluation: moderate complexity, established patient	Performed by a physical therapist to document functional mobility limitations supporting `K0852` medical necessity.
`97165`	Occupational therapy evaluation: low complexity	OT evaluation for seating and activities of daily living that supports configuration decisions for `K0852`.
`97530`	Therapeutic activities, direct (one-on-one)	Therapy sessions for transfer training and wheelchair propulsion practice after delivery.
`97760`	Orthotic(s)/prosthetic(s) management and training, initial device	Training and education for patient and caregiver on use of complex mobility device.
`99070`	Supplies and materials (unrelated to other procedures)	Used to bill nonroutine supplies or custom cushions related to the wheelchair when payer allows.