K0886 Power Wheelchair HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS K0886: Power Wheelchair, Group 4 Heavy Duty, 301–450 lb Capacity

HCPCS Level II code K0886 denotes a heavy-duty group 4 power wheelchair with multiple power options and a sling/solid seat/back, supporting patients with a weight capacity of 301 to 450 pounds. This code matters nationally because it identifies higher-capacity mobility devices that address clinical needs for bariatric and heavy-duty users, implicating DME coverage policies, supplier processes, and durable medical equipment inventories. Common payment and coverage decisions for this device affect access to mobility and patient safety.

Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers can expect an overview of the clinical context for prescribing and supplying such devices, typical sites of service where these devices are delivered and fitted, and a synthesis of coverage and billing themes. The publication summarizes standard coding description, common modifiers used with DME claims, and topics relevant to claims processing and documentation requirements. Where specific payer policy details or comparative benchmarks are unavailable in the input, the text will note that data is not provided rather than infer policy. This resource is intended to inform billing staff, DME suppliers, clinicians, and policy analysts about the role of K0886 in mobility device billing and operational workflows at a national level.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK0886HCPCSpower-wheelchairdurable-medical-equipmentbariatric-mobilitymedical-billingDME-suppliers

Billing Code Overview

HCPCS Level II code K0886 describes a power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, with a patient weight capacity of 301 to 450 pounds. This device is a durable medical equipment mobility aid intended for patients who require a heavy-duty power wheelchair due to elevated weight capacity needs.

Service type: Durable medical equipment (power mobility device) provisioning and fitting
Typical site of service: Durable medical equipment supplier locations, outpatient clinics, long-term care facilities, and patient residences where delivery and setup occur

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with mobility-limiting neuromuscular disease, severe osteoarthritis, morbid obesity, or spinal cord injury who requires a heavy-duty power wheelchair with a sling or solid seat/back and a patient weight capacity of 301 to 450 pounds. The clinical workflow begins with a physician or advanced practice clinician evaluation documenting functional limitations, safety concerns, and prior mobility aids tried. A supplier conducts a face-to-face assessment, performs objective measurements (seat depth/width, transfer needs, turning radius), and documents specialized power options (multiple power seating controls, tilt/recline, power elevating seat) required for pressure relief, transfers, or activities of daily living. Durable medical equipment documentation includes the power wheelchair specification (K0886), justification of weight capacity, trial results or demonstration, and a plan of care signed by the prescribing clinician. The supplier arranges delivery, fitting, user training, and follow-up for adjustments and repairs. Typical sites of service include the patient’s home, outpatient durable medical equipment supplier facility, or a rehabilitation clinic. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional effort or complexity in customization or complex seating system requires substantially greater resources than typical for the wheelchair fitting.

HCPCS Level II K0824: Power Wheelchair, Heavy Duty 301–450 lb

HCPCS-K0105-IV-HANGER-INFUSION-SUPPLY

HCPCS K0105: IV Hanger, Each

HCPCS-K0013-CUSTOM-MOTORIZED-POWER-WHEELCHAIR-BASE

HCPCS K0013: Custom Motorized/Power Wheelchair Base

HCPCS-K0003-LIGHTWEIGHT-WHEELCHAIR

HCPCS K0003: Lightweight Wheelchair

HCPCS-K0830-POWER-WHEELCHAIR-GROUP-2-SEAT-ELEVATOR-300LB

HCPCS K0830: Power Wheelchair Group 2 with Seat Elevator, ≤300 lb

HCPCS-K0672-LOWER-EXTREMITY-ORTHOSIS-REMOVABLE-SOFT-INTERFACE-REPLACEMENT

HCPCS K0672: Lower Extremity Orthosis Removable Soft Interface, Replacement

HCPCS-K0006-HEAVY-DUTY-WHEELCHAIR

HCPCS Level II K0006: Heavy Duty Wheelchair

HCPCS-K0007-EXTRA-HEAVY-DUTY-WHEELCHAIR

HCPCS K0007: Extra Heavy Duty Wheelchair

HCPCS-K0037-HIGH-MOUNT-FLIP-UP-FOOTREST

HCPCS K0037: High Mount Flip-Up Footrest, Each

HCPCS-K0853-POWER-WHEELCHAIR-VERY-HEAVY-DUTY-CAPTAINS-CHAIR-451-600LBS

HCPCS K0853: Power Wheelchair, Very Heavy Duty Captains Chair

Showing 1–10 of 135

Taxonomy Code	Specialty	Notes
`2084P0800X`	Physical Medicine & Rehabilitation	Physiatrist who prescribes complex mobility equipment and documents functional need.
`208M00000X`	Physical Therapist	Performs functional mobility assessment, seating and mobility evaluations, and training.
`367A00000X`	Occupational Therapist	Performs ADL-focused seating assessments, transfers training, and environmental fit.
`208D00000X`	Orthotist/Prosthetist	Provides specialized seating systems, modifications, and custom fabrication related to the wheelchair.
`362X00000X`	Durable Medical Equipment Supplier	Supplier organization taxonomy for fitting, delivery, and maintenance of the power wheelchair.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M16.11`	Unilateral primary osteoarthritis, right hip	Osteoarthritis causing severe pain and mobility limitation leading to need for power mobility.
`M54.5`	Low back pain	Chronic pain impairing ambulation, increasing need for powered mobility support.
`G82.20`	Paraplegia, unspecified	Significant mobility impairment requiring full-time power wheelchair with high weight capacity.
`G82.50`	Quadriplegia, unspecified	Severe impairment of all limbs necessitating power wheelchair with multiple power options and specialized seating.
`E66.01`	Morbid (severe) obesity due to excess calories	Excess body weight necessitating a heavy duty power wheelchair with capacity 301–450 pounds.
`M54.2`	Cervicalgia	Neck pain that limits safe manual wheelchair use and may require power mobility.
`R26.2`	Difficulty in walking, not elsewhere classified	Functional gait impairment supporting need for a power wheelchair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97542`	Wheelchair management (e.g., assessment, fitting) including power wheelchair seating, each 15 minutes	Used for clinical wheelchair/mobility seating assessments and training sessions that support selection and customization of the power wheelchair.
`97001`	Physical therapy evaluation	Initial PT evaluation often performed prior to prescription to document functional deficits and justify the need for a power wheelchair.
`97112`	Neuromuscular re-education	Therapy code used during training to improve transfers and control when integrating a power wheelchair into daily activities.
`99070`	Supplies and materials (noncovered)	Used by suppliers to bill for additional supplies or accessories not included in the base wheelchair fee when permitted by payer.
`99080`	Special reports and forms	Used when payors (e.g., Medicare) require detailed supporting documentation, letters of medical necessity, or complex justification for heavy-duty equipment.

OpenPayer