HCPCS K-Codes
Durable Medical Equipment for Medicare Administrative Contractors (DME MACs)

Temporary K codes are developed by the DME MACs to report supplies and other products for which a national code has not yet been developed. Payment jurisdiction lies with the DME MACs unless otherwise specified.

• K0841

  Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

• K0842

  Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds

• K0843

  Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds

• K0848

  Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds

• K0849

  Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds

• K0850

  Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds

• K0851

  Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds

• K0852

  Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds

• K0853

  Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds

• K0854

  Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more

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• K0855

  Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more

• K0856

  Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

• K0857

  Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds

• K0858

  Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds

• K0859

  Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds

• K0860

  Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds

• K0861

  Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

• K0862

  Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds

• K0863

  Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds

• K0864

  Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more

• K0868

  Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds

• K0869

  Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds

• K0870

  Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds

• K0871

  Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds

• K0877

  Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

• K0878

  Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds

• K0879

  Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds

• K0880

  Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds

• K0884

  Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

• K0885

  Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds

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• K0886

  Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds

• K0890

  Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds

• K0891

  Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds

• K0898

  Power wheelchair, not otherwise classified

• K0899

  Power mobility device, not coded by dme pdac or does not meet criteria

• K0900

  Customized durable medical equipment, other than wheelchair

• K0901

  Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf

• K0902

  Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf

• K0903

  For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each

• K1001

  Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type

• K1002

  Cranial electrotherapy stimulation (ces) system, any type

• K1003

  Whirlpool tub, walk-in, portable

• K1004

  Low frequency ultrasonic diathermy treatment device for home use

• K1005

  Disposable collection and storage bag for breast milk, any size, any type, each

• K1006

  Suction pump, home model, portable or stationary, electric, any type, for use with external urine management system

• K1007

  Bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors

• K1009

  Speech volume modulation system, any type, including all components and accessories

• K1010

  Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each

• K1011

  Activation device for intraurethral drainage device with valve, replacement only, each

• K1012

  Charger and base station for intraurethral activation device, replacement only