Summary & Overview
HCPCS K0891: Power Wheelchair Group 5 Pediatric, Up to 125 lb
HCPCS Level II code K0891 designates a pediatric group 5 power wheelchair with multiple power options and a sling/solid seat and back, rated for patient weights up to 125 pounds. This durable medical equipment code is nationally relevant because it applies to specialized mobility devices for children and adolescents, affecting coverage determinations, prior authorization workflows, and supplier billing practices across public and private payers. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what K0891 represents clinically and operationally, how payers typically handle coverage and documentation requirements, and where policy updates or coding guidance may influence claims processing. The publication provides benchmarks for utilization and reimbursement patterns where available, summarizes common payer requirements (such as medical necessity documentation and device specifications), and outlines clinical contexts in which a group 5 pediatric power wheelchair is typically considered. Data not available in the input is noted where relevant. The focus is national in scope and intended for billing managers, DME suppliers, clinicians involved in mobility assessments, and policy analysts seeking a concise reference to K0891.
Billing Code Overview
HCPCS Level II code K0891 describes a power wheelchair, group 5 pediatric, with multiple power options and a sling/solid seat and back, designed for a patient weight capacity up to and including 125 pounds. The service type is durable medical equipment (power mobility device) intended to provide mobility assistance for pediatric patients with limited ambulation. Typical site of service includes outpatient durable medical equipment provision, home use, and pediatric rehabilitation settings.
Clinical & Coding Specifications
Clinical Context
A 10-year-old child with spastic quadriplegic cerebral palsy and limited ambulatory potential requires a pediatric Group 5 power wheelchair with multiple power options and a sling/solid seat and back to support posture and mobility. The child weighs 110 pounds and has progressive functional decline in transfers and mobility, uses a wheelchair full-time for community mobility and school, and requires power tilt and power seat elevation for pressure relief and positioning during the school day.
The clinical workflow begins with a physician or pediatric physiatrist evaluation documenting the medical necessity for a Group 5 pediatric power wheelchair K0891, including history, physical exam, functional mobility assessment, documented environment barriers (school, home), and prior conservative mobility equipment trials. A licensed therapist (OT/PT) performs a detailed seating and mobility evaluation outlining postural support needs, recommended power functions (e.g., power tilt, power seat elevation), and measurement for a sling/solid seat and back. The supplier selects and programs the K0891 base to match the child’s weight capacity (up to 125 pounds) and specified power options, obtains prior authorization from payors, and trains the child and caregivers on safe operation, maintenance, and follow-up. Clinical documentation includes the prescription with detailed parameters, therapist evaluation, supplier invoice, manufacturer specifications, and any mobility device trial notes.
Coding Specifications
| Modifier | Description | When to Use |
|---|