Summary & Overview
HCPCS K0890: Pediatric Group 5 Power Wheelchair, Single Power Option
HCPCS Level II code K0890 denotes a pediatric power wheelchair Group 5 with a single power option, sling or solid seat/back, and a patient weight capacity up to and including 125 pounds. This DME classification matters nationally because it defines coverage and billing for specialized mobility devices used by children and adolescents who have significant mobility impairments. Clear coding supports appropriate access to mobility equipment and informs reimbursement for suppliers and clinical teams.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage relevance, payer scope, and clinical context for device selection. The publication summarizes typical service settings, the clinical scenarios in which a Group 5 pediatric power wheelchair is used, and the operational considerations for billing this HCPCS item.
The report provides benchmarks and practical policy context: typical utilization settings, payer coverage patterns, and coding considerations that affect procurement and documentation. Where specific payer policies or related coding details are not available in the input, the publication indicates that data is not available in the input. The content is intended for a national audience of providers, suppliers, and policy analysts seeking a concise reference on HCPCS Level II code K0890 and its role in pediatric mobility device services.
Billing Code Overview
HCPCS Level II code K0890 describes a power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds. This item is a durable medical equipment (DME) mobility device intended for pediatric patients who require a power-operated wheelchair for mobility assistance.
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Service type: Durable medical equipment — power wheelchair provision and fitting
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Typical site of service: Home or community settings where the pediatric patient uses a power wheelchair for mobility (examples: private residence, school, or outpatient clinic for evaluation and fitting)
Clinical & Coding Specifications
Clinical Context
A pediatric patient weighing 110 pounds with severe mobility impairment due to spastic cerebral palsy requires a Group 5 power wheelchair (K0890) with a single power option and sling/solid seat and back. The clinical workflow begins with a physician or pediatric physiatrist evaluation documenting functional limitations, mobility goals, and trial outcomes with a standard wheelchair. A licensed therapist (physical or occupational) performs a detailed mobility assessment, documents transfer ability, seating needs, postural support requirements, and the justification for a pediatric Group 5 power base with the specified weight capacity. The durable medical equipment (DME) supplier conducts a home visit to confirm access, clearance, and measurement needs, selects appropriate controls (e.g., joystick), and arranges customization such as seating contoured inserts. Documentation includes a detailed face-to-face evaluation, objective mobility tests (e.g., 6-minute push/wheel test adapted for power mobility), seating assessment, trial or training notes, and a detailed equipment narrative supporting medical necessity. Prior authorization is often obtained from payors before delivery. Delivery includes device setup, patient and caregiver training, and follow-up for adjustments and objective demonstration of safe use and benefit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery |