Summary & Overview
HCPCS K0858: Group 3 Heavy-Duty Power Wheelchair, 301–450 lbs
HCPCS Level II code K0858 designates a Group 3 heavy-duty power wheelchair with a single power option and a sling/solid seat and back, sized for patients weighing 301 to 450 pounds. This equipment classification matters nationally because it captures coverage and billing for higher-capacity power mobility devices that serve individuals with significant mobility limitations and higher weight requirements. Appropriate coding affects access to durable medical equipment and aligns payer policies with clinical needs.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of what K0858 represents, payer coverage patterns and benchmarks where available, relevant billing considerations, and the clinical context for prescribing and supplying group 3 heavy-duty power wheelchairs. The publication highlights common modifiers used with durable medical equipment claims and summarizes typical sites of service and supplier responsibilities. Data not available in the input is noted where applicable.
This summary serves clinicians, durable medical equipment suppliers, and billing professionals seeking a concise national view of the purpose and billing context for HCPCS Level II code K0858.
Billing Code Overview
HCPCS Level II code K0858 describes a power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds. This item is a durable medical equipment mobility device intended for individuals who require a heavy-duty power wheelchair to accommodate higher weight capacity and provide mobility assistance.
Service Type: Durable Medical Equipment (Power Mobility Device)
Typical Site of Service: Home or community settings where a durable power wheelchair is used for mobility and activities of daily living. Clinical and durable equipment suppliers coordinate delivery, fitting, and training in outpatient, home-health, or supplier-based settings.
Clinical & Coding Specifications
Clinical Context
A 54-year-old male patient with morbid obesity (body weight 340 pounds) and lumbar spine degenerative disease is evaluated in an outpatient durable medical equipment clinic for mobility impairment. The patient has progressive difficulty ambulating due to back pain and deconditioning and requires a power wheelchair capable of supporting higher weight capacity. A physical therapist documents the mobility assessment including seated weight-bearing, transfer ability, and home environment barriers. The physician orders a heavy-duty Group 3 power wheelchair with a single power option and a sling/solid seat/back to accommodate the patient’s weight range of 301 to 450 pounds. Prior to delivery, the supplier performs a face-to-face visit, documents medical necessity, obtains prior authorization from the patient’s payor, and arranges a home trial and wheelchair configuration including seating and positioning adjustments. Follow-up visits include training for safe operation, skin integrity checks, and any necessary adjustments or accessories. Typical sites of service include outpatient DME supplier clinics, patient homes for delivery and setup, and outpatient rehabilitation clinics for evaluation and training.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when procurement or delivery required substantially greater effort (complex customization) than usual. |