HCPCS Level II K0855: Power Wheelchair, Extra Heavy Duty, Captain's Chair - OpenPayer

Summary & Overview

HCPCS Level II K0855: Power Wheelchair, Extra Heavy Duty, Captain's Chair

HCPCS Level II code K0855 identifies an extra heavy-duty group 3 power wheelchair with a captain's chair and a patient weight capacity of 601 pounds or more. This classification matters nationally because it addresses the needs of patients requiring bariatric-capable powered mobility devices and informs coverage, procurement, and clinical care plans for durable medical equipment. Reimbursement and coverage policies for high-capacity power wheelchairs affect access for patients with severe mobility limitations and the equipment choices of providers and suppliers.

Key payers covered in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical and equipment meaning, typical sites of service, and the payer landscape. The publication summarizes benchmarks and coverage considerations, highlights relevant billing and documentation issues, and outlines where policy updates or payment variances commonly occur. Where specific data elements are not provided in the input, the text notes "Data not available in the input." The content is intended for national audiences including clinicians, DME suppliers, billing professionals, and policy analysts seeking a clear reference for K0855.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0855HCPCS Level IIpower wheelchairdurable medical equipmentbariatric mobilitymedical billingwheelchair equipmentoutpatient DME

Billing Code Overview

HCPCS Level II code K0855 describes a power wheelchair, group 3 extra heavy duty, captain's chair, patient weight capacity 601 pounds or more. This equipment classification denotes a high-capacity, power-assist mobility device designed for patients who require a durable, extra heavy-duty frame and seating system to support very high weight capacities.

Service type: Durable medical equipment (power mobility device)
Typical site of service: Durable medical equipment provided in outpatient settings, home delivery, or specialty medical equipment suppliers

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with morbid obesity (body weight 680 pounds), chronic lower extremity weakness from a prior spinal cord injury, and progressive osteoarthritis presents for durable medical equipment evaluation for mobility assistance. The supplier documents that a standard power wheelchair will not safely support the patient’s weight and functional needs. A Group 3 extra heavy duty power wheelchair with captain’s chair seating and minimum patient weight capacity of 601 pounds or more is ordered (K0855). The clinical workflow includes: a physician or qualified practitioner completing a face-to-face evaluation documenting mobility limitations, functional goals, and medical necessity; completion of a detailed equipment justification specifying weight capacity, seating needs, and environmental considerations; prior authorization submission to the patient’s insurer; delivery and in-home setup by a qualified mobility equipment supplier; and a follow-up functional assessment and training session to document safe use and fit. Typical sites of service are outpatient durable medical equipment supplier facilities, the patient’s home for delivery and setup, and outpatient clinics for evaluation and follow-up.

Coding Specifications

Modifier	Description	When to Use
`00`	Unspecified modifier	Use when no other modifier applies (rare; payer-specific rules).

Related Codes

HCPCS-K0105-IV-HANGER-INFUSION-SUPPLY

HCPCS K0105: IV Hanger, Each

HCPCS-K0869-POWER-WHEELCHAIR-GROUP-4-CAPTAINS-CHAIR-300LB-CAPACITY

HCPCS K0869: Power Wheelchair Group 4, Captain's Chair, ≤300 lb

HCPCS-K0009-OTHER-MANUAL-WHEELCHAIR-BASE

HCPCS K0009: Other Manual Wheelchair/Base

HCPCS-K0825-POWER-WHEELCHAIR-HEAVY-DUTY-301-450-LB-CAPACITY

HCPCS K0825: Power Wheelchair, Group 2 Heavy Duty, 301–450 lb Capacity

HCPCS-LEVEL-II-K0739-DME-REPAIR-TECHNICIAN-LABOR-15-MIN

HCPCS Level II K0739: Technician Labor for DME Repair, per 15 Minutes

HCPCS-K0890-POWER-WHEELCHAIR-GROUP-5-PEDIATRIC

HCPCS K0890: Pediatric Group 5 Power Wheelchair, Single Power Option

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

HCPCS K0010: Standard Weight Frame Motorized/Power Wheelchair

HCPCS-K0672-LOWER-EXTREMITY-ORTHOSIS-REMOVABLE-SOFT-INTERFACE-REPLACEMENT

HCPCS K0672: Lower Extremity Orthosis Removable Soft Interface, Replacement

HCPCS-K0802-POWER-OPERATED-VEHICLE-VERY-HEAVY-DUTY-451-600-LB

HCPCS Level II K0802: Power Operated Vehicle, Very Heavy Duty 451–600 lb

HCPCS-K0007-EXTRA-HEAVY-DUTY-WHEELCHAIR

HCPCS K0007: Extra Heavy Duty Wheelchair

Showing 1–10 of 135

Taxonomy Code	Specialty	Notes
`228100000X`	Physical Medicine & Rehabilitation	Clinicians perform functional mobility evaluations and prescribe complex mobility devices.
`261QP2300X`	Physical Therapist	Provides seating evaluations, mobility training, and follow-up.
`331K00000X`	Occupational Therapist	Performs activities of daily living assessments and custom seating recommendations.
`334600000X`	Durable Medical Equipment & Supplies	Suppliers deliver, fit, and service power wheelchairs.
`207RH0000X`	Family Medicine	Primary care providers often document medical necessity and coordinate authorization.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E66.01`	Morbid (severe) obesity due to excess calories	High patient weight that necessitates an extra heavy duty power wheelchair with capacity ≥601 pounds.
`G82.50`	Paralysis, unspecified lower limb, unspecified	Lower extremity paralysis increases need for powered mobility with high weight capacity.
`G82.20`	Paraplegia, unspecified	Chronic paraplegia frequently requires a power wheelchair for mobility and independence.
`M16.11`	Unilateral primary osteoarthritis, right hip	Severe joint disease limiting ambulation and necessitating powered mobility.
`M17.11`	Unilateral primary osteoarthritis, right knee	Advanced knee osteoarthritis causing functional mobility impairment.
`R26.2`	Difficulty in walking, not elsewhere classified	Functional gait impairment commonly supports medical necessity for a power wheelchair.
`Z74.09`	Other reduced mobility	General reduced mobility status used to document long-term need for mobility aids.
`Z99.3`	Dependence on wheelchair	Indicates current reliance on a wheelchair and supports ongoing need for appropriate replacement or upgrade.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic(s) management and training, initial encounter, each 15 minutes	Used for training the patient in safe operation and transferring with the power wheelchair.
`97530`	Therapeutic activities, direct (one-on-one) patient contact	Used for functional mobility and ADL training related to wheelchair use.
`92507`	Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual	Data not directly related; include only if combined services are billed concurrently.
`99456`	Work related or medical disability examination by the treating physician with form completion	Used when formal documentation for disability or benefit determination is required to justify the device.
`99499`	Unlisted evaluation and management service	Used payer-specifically when no other code accurately describes a complex seating or mobility evaluation.

Note: If a payer requires different or additional evaluation codes, the supplier and clinicians apply payer-specific billing policies and prior authorization requirements.