Summary & Overview
HCPCS K0862: Power Wheelchair, Group 3 Heavy Duty, 301–450 lb Capacity
HCPCS Level II code K0862 represents a heavy-duty, Group 3 power wheelchair with multiple power options and a sling or solid seat/back designed for patients with weight capacity between 301 and 450 pounds. This classification matters nationally because it identifies a high-capacity mobility device intended for individuals with greater body mass or complex mobility needs; accurate coding affects coverage determinations, device procurement, and clinical care planning.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage considerations across major payers, common billing modifiers in use, and the clinical context for selecting a Group 3 heavy-duty power wheelchair. The publication summarizes service and site-of-service expectations for durable medical equipment suppliers and seating clinics, and highlights areas where policy updates or payer-specific documentation requirements commonly influence claims adjudication.
The content provides practical benchmarks for code classification and typical clinical use without offering clinical recommendations. Where specific payer policy details, taxonomies, or diagnosis requirements are not available in the input, the text notes that data is not available in the input.
Billing Code Overview
HCPCS Level II code K0862 describes a power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, with a patient weight capacity of 301 to 450 pounds.
Service type: Durable Medical Equipment (power mobility device)
Typical site of service: Home or community settings where power mobility is used for activities of daily living; device provision and fitting occur in durable medical equipment suppliers' facilities, seating clinics, or home visits.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male with morbid obesity (body weight 340 lb) and progressive lower-extremity weakness from diabetic peripheral neuropathy and lumbar stenosis leading to severe mobility limitation. The patient requires a durable medical equipment evaluation by a rehabilitation physician or physical medicine and rehabilitation specialist to determine medical necessity for a group 3 heavy-duty power wheelchair. The equipment order is placed after documentation of functional assessment, goals of use (community ambulation, home and outdoor mobility), inability to safely propel a manual wheelchair, and weight capacity requirements of 301–450 pounds. A certified ATP (Assistive Technology Professional) or durable medical equipment supplier performs seating and mobility evaluation, documents measurements for sling/solid seat and back, configures power options (multiple power functions such as reclining, tilt, elevating leg rests), and coordinates delivery. Typical site of service is outpatient DME supplier setting or patient’s home for delivery and setup, with follow-up visits in outpatient rehab or home for training and adjustment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Used when no special circumstances apply. |
22 |