Summary & Overview
HCPCS K0879: Power Wheelchair, Heavy Duty, 301–450 lb Capacity
HCPCS Level II code K0879 identifies a group 4 heavy-duty power wheelchair with a single power option, sling or solid seat/back, and a patient weight capacity of 301 to 450 pounds. This equipment category addresses mobility needs for individuals requiring robust power chairs capable of supporting higher body weights. Nationally, proper coding of heavy-duty power wheelchairs affects durable medical equipment coverage, supplier billing, and access to clinically appropriate mobility solutions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer-specific coverage considerations, common modifiers in use, and where K0879 fits within the broader durable medical equipment benefit landscape.
Readers will learn: benchmarks for utilization and payment where available, policy updates and coverage criteria that commonly apply to heavy-duty power wheelchairs, and clinical context that informs medical necessity for higher-capacity devices. The report also highlights typical sites of service for provision and the service type classification. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code K0879 describes a power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds. This code represents a durable medical equipment product designed for patients who require heavy-duty power mobility with a higher weight capacity.
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Service type: Durable medical equipment — power mobility device
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Typical site of service: Durable medical equipment suppliers, home use, outpatient equipment provision
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male with severe mobility impairment from progressive lumbar spondylosis and morbid obesity (body weight 340 pounds) who requires a durable medical equipment evaluation for safe, independent mobility. The patient uses a manual wheelchair that is no longer safe given declining endurance and strength and frequent pressure relief needs. A licensed physical therapist and a physician (physiatrist or orthopedic surgeon) perform an in-person mobility assessment to document medical necessity, seating requirements, and environmental considerations. The clinical workflow includes: referral from a treating physician; face-to-face evaluation with standardized mobility and functional assessments (e.g., 6-minute walk if tolerated, transfers, seating interface review); documentation of body weight and measurements to confirm compatibility with a Group 4 heavy-duty power wheelchair; trial of a comparable power mobility base or demonstration unit when available; completion of a detailed written order specifying K0879 (Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds), options, and supplier information; submission of supporting notes, mobility assessment, and photos to the durable medical equipment supplier and payor for prior authorization if required. Typical site of service is the hospital outpatient clinic, rehabilitation clinic, long-term care facility, or supplier showroom where evaluation and delivery occur. Delivery includes wheelchair setup, user training, adjustments, and documentation of beneficiary acceptance and willing caregiver training as needed.
Coding Specifications
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