Coding: Browse HCPCS Level II 2020 Edition

Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

K0001 - K0195 Temporary Codes Assigned to DME Regional Carriers - Wheelchairs and Accessories

K0001

Standard wheelchair

short

Standard wheelchair

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0002

Standard hemi (low seat) wheelchair

short

Stnd hemi (low seat) whlchr

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0003

Lightweight wheelchair

short

Lightweight wheelchair

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0004

High strength, lightweight wheelchair

short

High strength ltwt whlchr

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0005

Ultralightweight wheelchair

short

Ultralightweight wheelchair

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0006

Heavy duty wheelchair

short

Heavy duty wheelchair

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0007

Extra heavy duty wheelchair

short

Extra heavy duty wheelchair

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0008

Custom manual wheelchair/base

short

Cstm manual wheelchair/base

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0009

Other manual wheelchair/base

short

Other manual wheelchair/base

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0010

Standard - weight frame motorized/power wheelchair

short

Stnd wt frame power whlchr

MUE

Location	Ajudication Indicator	Rationale
PRA	3 Date of Service Edit: Clinical	CMS Policy
OPH	3 Date of Service Edit: Clinical	CMS Policy
DME	3 Date of Service Edit: Clinical	Published Contractor Policy

K0011

Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking

short

Stnd wt pwr whlchr w control

MUE

Location	Ajudication Indicator	Rationale
PRA	3 Date of Service Edit: Clinical	CMS Policy
OPH	3 Date of Service Edit: Clinical	CMS Policy
DME	3 Date of Service Edit: Clinical	Published Contractor Policy

K0012

Lightweight portable motorized/power wheelchair

short

Ltwt portbl power whlchr

MUE

Location	Ajudication Indicator	Rationale
PRA	3 Date of Service Edit: Clinical	CMS Policy
OPH	3 Date of Service Edit: Clinical	CMS Policy
DME	3 Date of Service Edit: Clinical	Published Contractor Policy

K0013

Custom motorized/power wheelchair base

short

Custom power whlchr base

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0014

Other motorized/power wheelchair base

short

Other power whlchr base

MUE

Location	Ajudication Indicator	Rationale
PRA	3 Date of Service Edit: Clinical	CMS Policy
OPH	3 Date of Service Edit: Clinical	CMS Policy
DME	3 Date of Service Edit: Clinical	Published Contractor Policy

K0015

Detachable, non-adjustable height armrest, replacement only, each

short

Detach non-adj ht armrst rep

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0017

Detachable, adjustable height armrest, base, replacement only, each

short

Detach adjust armrest base

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0018

Detachable, adjustable height armrest, upper portion, replacement only, each

short

Detach adjust armrst upper

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0019

Arm pad, replacement only, each

short

Arm pad repl, each

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0020

Fixed, adjustable height armrest, pair

short

Fixed adjust armrest pair

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Code Descriptor / CPT Instruction

K0037

High mount flip-up footrest, each

short

Hi mount flip-up footrest ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0038

Leg strap, each

short

Leg strap each

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	3 Date of Service Edit: Clinical	Anatomic Consideration

K0039

Leg strap, h style, each

short

Leg strap h style each

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	3 Date of Service Edit: Clinical	Anatomic Consideration

K0040

Adjustable angle footplate, each

short

Adjustable angle footplate

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0041

Large size footplate, each

short

Large size footplate each

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0042

Standard size footplate, replacement only, each

short

Standard size ftplate rep ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0043

Footrest, lower extension tube, replacement only, each

short

Ftrst lowr exten tube rep ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0044

Footrest, upper hanger bracket, replacement only, each

short

Ftrst upr hanger brac rep ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0045

Footrest, complete assembly, replacement only, each

short

Ftrst compl assembly repl ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0046

Elevating legrest, lower extension tube, replacement only, each

short

Elev lgrst lwr exten repl ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0047

Elevating legrest, upper hanger bracket, replacement only, each

short

Elev legrst upr hangr rep ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0050

Ratchet assembly, replacement only

short

Ratchet assembly replacement

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Nature of Equipment

K0051

Cam release assembly, footrest or legrest, replacement only, each

short

Cam rel asm ft/legrst rep ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Nature of Equipment

K0052

Swingaway, detachable footrests, replacement only, each

short

Swingaway detach ftrest repl

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0053

Elevating footrests, articulating (telescoping), each

short

Elevate footrest articulate

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

K0056

Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair

short

Seat ht <17 or >=21 ltwt wc

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0065

Spoke protectors, each

short

Spoke protectors

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Nature of Equipment

K0069

Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each

short

Rr whl compl sol tire rep ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Nature of Equipment

K0070

Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each

short

Rr whl compl pne tire rep ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Nature of Equipment

K0071

Front caster assembly, complete, with pneumatic tire, replacement only, each

short

Fr cstr comp pne tire rep ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Nature of Equipment

K0072

Front caster assembly, complete, with semi-pneumatic tire, replacement only, each

short

Fr cstr semi-pne tire rep ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Nature of Equipment

K0073

Caster pin lock, each

short

Caster pin lock each

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Nature of Equipment

K0077

Front caster assembly, complete, with solid tire, replacement only, each

short

Fr cstr asmb sol tire rep ea

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Nature of Equipment

K0098

Drive belt for power wheelchair, replacement only

short

Drive belt for pwc, repl

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	3 Date of Service Edit: Clinical	Clinical: CMS Workgroup

K0105

Iv hanger, each

short

Iv hanger

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	2 Date of Service Edit: Policy	Nature of Equipment

K0108

Wheelchair component or accessory, not otherwise specified

short

W/c component-accessory nos

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy

K0195

Elevating leg rests, pair (for use with capped rental wheelchair base)

short

Elevating whlchair leg rests

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	1.0	3 Date of Service Edit: Clinical	Code Descriptor / CPT Instruction