Summary & Overview
HCPCS K0861: Power Wheelchair Group 3 Standard, 300 lb Capacity
HCPCS Level II code K0861 identifies a Group 3 standard power wheelchair with multiple power options and a sling/solid seat/back, rated for patients up to and including 300 pounds. This code covers complex durable medical equipment used to restore mobility for patients with significant functional limitations and is widely relevant to durable medical equipment suppliers, rehabilitation providers, and payers managing mobility benefit programs. Nationally, power wheelchair coding drives coverage, prior authorization, and rental vs. purchase determinations.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical function and typical sites of service, common modifiers and billing considerations, and how K0861 fits into durable medical equipment workflows. The publication presents benchmarks where available, highlights relevant billing and policy considerations that affect authorization and reimbursement, and summarizes the clinical contexts in which this device is used. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code K0861 describes a power wheelchair, group 3 standard, multiple power option, sling/solid seat/back with a patient weight capacity up to and including 300 pounds. This equipment classification denotes a heavy-duty power mobility device intended for patients who require complex seating and drive control features beyond basic power wheelchair configurations.
Service type: DME — Power Wheelchair
Typical site of service: Outpatient durable medical equipment suppliers, home medical equipment delivery, and patient residence
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with progressive mobility impairment due to advanced Parkinson disease and chronic lower extremity weakness is evaluated by a durable medical equipment (DME) supplier and a physiatrist for a power wheelchair. The clinician documents functional limitations including inability to ambulate safely in the community, frequent falls, and need for a powered mobility device to perform activities of daily living. The patient requires a group 3 standard power wheelchair with multiple power options and a sling/solid seat/back that supports a patient weight capacity up to and including 300 pounds. The workflow includes a comprehensive functional assessment, documentation of medical necessity, selection of the appropriate configuration, prior authorization submission to the payer, delivery and setup in the patient’s home, and patient/caregiver training. Post-delivery follow-up addresses seating adjustments, pressure-relief strategies, and device troubleshooting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Service not specified in the list of modifiers | Rarely used; use only if payer requires a default code when no other modifier applies |
22 |