Summary & Overview
HCPCS Level II K0864: Power Wheelchair, Extra Heavy Duty, 601+ lbs
HCPCS Level II code K0864 designates an extra heavy-duty Group 3 power wheelchair with multiple power options, a sling or solid seat/back, and a patient weight capacity of 601 pounds or more. This code captures high-capacity power mobility devices used for patients with severe mobility limitations and elevated weight requirements, making it an important category for durable medical equipment coverage and care planning nationwide. Nationally, coverage and billing for such high-capacity power wheelchairs affect hospital discharge planning, durable medical equipment suppliers, home health coordinators, and payers managing long-term mobility needs.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what K0864 represents, typical sites of service, and the clinical context for use. The publication outlines benchmark elements readers can expect, including reimbursement patterns, documentation and medical necessity considerations, and payer-specific coverage trends where available. It also summarizes policy updates relevant to high-capacity power mobility devices and clarifies the clinical scenarios that commonly drive use of an extra heavy-duty Group 3 power wheelchair. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related billing codes.
Billing Code Overview
HCPCS Level II code K0864 describes a power wheelchair, group 3 extra heavy duty design with multiple power options, a sling/solid seat and back, and a patient weight capacity of 601 pounds or more. This item is a durable medical equipment mobility device intended for patients who require a high-capacity, motorized wheelchair to support significant body weight and provide custom power features.
Service Type: Durable Medical Equipment (Power Mobility Device)
Typical Site of Service: Outpatient medical equipment suppliers, home use, long-term care facilities
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related billing codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is a morbidly obese adult with limited mobility due to severe osteoarthritis, spinal cord injury, or neuromuscular weakness whose body weight exceeds 601 pounds. The patient is evaluated by a physiatrist or durable medical equipment (DME) specialist following an in-person functional mobility assessment and seating evaluation. The clinical workflow includes: referral from the primary care physician or specialist; documentation of medical necessity showing inability to safely ambulate or transfer in standard seating; objective measurements (weight, hip width, sitting tolerance); trial of conservative measures (physical therapy, cane/walker, standard power wheelchair if feasible); an occupational therapy or physical therapy report documenting propulsion, transfers, and pressure-management needs; a letter of medical necessity from the prescribing clinician; and DME supplier review for fit, customization, and delivery. Prior authorization is frequently obtained from payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare. Delivery includes patient training, seat and control programming, and setup for safe transfers and transport.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no special circumstances apply to the item or service. |