|
K0800 |
 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds
| short | Pov group 1 std up to 300lbs |
| 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 |
|
|
|
|
K0801 |
|
Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds
| short | Pov group 1 hd 301-450 lbs |
| 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 |
|
|
|
|
K0802 |
|
Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds
| short | Pov group 1 vhd 451-600 lbs |
| 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 |
|
|
|
|
K0806 |
|
Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds
| short | Pov group 2 std up to 300lbs |
| 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 |
|
|
|
|
K0807 |
|
Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds
| short | Pov group 2 hd 301-450 lbs |
| 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 |
|
|
|
|
K0808 |
|
Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds
| short | Pov group 2 vhd 451-600 lbs |
| 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 |
|
|
|
|
K0812 |
|
Power operated vehicle, not otherwise classified
| short | Power operated vehicle noc |
| 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 |
|
|
|
|
K0813 |
|
Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds
| short | Pwc gp 1 std port seat/back |
| 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 |
|
|
|
|
K0814 |
|
Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp 1 std port cap chair |
| 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 |
|
|
|
|
K0815 |
|
Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds
| short | Pwc gp 1 std seat/back |
| 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 |
|
|
|
|
K0816 |
|
Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp 1 std cap chair |
| 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 |
|
|
|
|
K0820 |
|
Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds
| short | Pwc gp 2 std port seat/back |
| 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 |
|
|
|
|
K0821 |
|
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp 2 std port cap chair |
| 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 |
|
|
|
|
K0822 |
|
Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
| short | Pwc gp 2 std seat/back |
| 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 |
|
|
|
|
K0823 |
|
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp 2 std cap chair |
| 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 |
|
|
|
|
K0824 |
|
Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
| short | Pwc gp 2 hd seat/back |
| 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 |
|
|
|
|
K0825 |
|
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds
| short | Pwc gp 2 hd cap chair |
| 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 |
|
|
|
|
K0826 |
|
Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
| short | Pwc gp 2 vhd seat/back |
| 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 |
|
|
|
|
K0827 |
|
Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds
| short | Pwc gp vhd cap chair |
| 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 |
|
|
|
|
K0828 |
|
Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more
| short | Pwc gp 2 xtra hd seat/back |
| 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 |
|
|
|
|
K0829 |
|
Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more
| short | Pwc gp 2 xtra hd cap chair |
| 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 |
|
|
|
|
K0830 |
|
Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds
| short | Pwc gp2 std seat elevate s/b |
| 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 |
|
|
|
|
K0831 |
|
Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp2 std seat elevate cap |
| 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 |
|
|
|
|
K0835 |
|
Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
| short | Pwc gp2 std sing pow opt s/b |
| 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 |
|
|
|
|
K0836 |
|
Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp2 std sing pow opt cap |
| 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 |
|
|
|
|
K0837 |
|
Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
| short | Pwc gp 2 hd sing pow opt s/b |
| 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 |
|
|
|
|
K0838 |
|
Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds
| short | Pwc gp 2 hd sing pow opt cap |
| 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 |
|
|
|
|
K0839 |
|
Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
| short | Pwc gp2 vhd sing pow opt s/b |
| 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 |
|
|
|
|
K0840 |
|
Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more
| short | Pwc gp2 xhd sing pow opt s/b |
| 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 |
|
|
|
|
K0841 |
|
Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
| short | Pwc gp2 std mult pow opt s/b |
| 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 |
|
|
|
|
K0842 |
|
Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp2 std mult pow opt cap |
| 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 |
|
|
|
|
K0843 |
|
Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
| short | Pwc gp2 hd mult pow opt s/b |
| 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 |
|
|
|
|
K0848 |
|
Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
| short | Pwc gp 3 std seat/back |
| 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 |
|
|
|
|
K0849 |
|
Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp 3 std cap chair |
| 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 |
|
|
|
|
K0850 |
|
Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
| short | Pwc gp 3 hd seat/back |
| 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 |
|
|
|
|
K0851 |
|
Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds
| short | Pwc gp 3 hd cap chair |
| 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 |
|
|
|
|
K0852 |
|
Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
| short | Pwc gp 3 vhd seat/back |
| 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 |
|
|
|
|
K0853 |
|
Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds
| short | Pwc gp 3 vhd cap chair |
| 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 |
|
|
|
|
K0854 |
|
Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more
| short | Pwc gp 3 xhd seat/back |
| 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 |
|
|
|
|
K0855 |
|
Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more
| short | Pwc gp 3 xhd cap chair |
| 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 |
|
|
|
|
K0856 |
|
Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
| short | Pwc gp3 std sing pow opt s/b |
| 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 |
|
|
|
|
K0857 |
|
Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp3 std sing pow opt cap |
| 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 |
|
|
|
|
K0858 |
|
Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds
| short | Pwc gp3 hd sing pow opt s/b |
| 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 |
|
|
|
|
K0859 |
|
Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds
| short | Pwc gp3 hd sing pow opt cap |
| 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 |
|
|
|
|
K0860 |
|
Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
| short | Pwc gp3 vhd sing pow opt s/b |
| 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 |
|
|
|
|
K0861 |
|
Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
| short | Pwc gp3 std mult pow opt s/b |
| 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 |
|
|
|
|
K0862 |
|
Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
| short | Pwc gp3 hd mult pow opt s/b |
| 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 |
|
|
|
|
K0863 |
|
Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
| short | Pwc gp3 vhd mult pow opt s/b |
| 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 |
|
|
|
|
K0864 |
|
Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more
| short | Pwc gp3 xhd mult pow opt s/b |
| 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 |
|
|
|
|
K0868 |
|
Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
| short | Pwc gp 4 std seat/back |
| 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 |
|
|
|
|
K0869 |
|
Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp 4 std cap chair |
| 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 |
|
|
|
|
K0870 |
|
Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
| short | Pwc gp 4 hd seat/back |
| 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 |
|
|
|
|
K0871 |
|
Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
| short | Pwc gp 4 vhd seat/back |
| 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 |
|
|
|
|
K0877 |
|
Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
| short | Pwc gp4 std sing pow opt s/b |
| 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 |
|
|
|
|
K0878 |
|
Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp4 std sing pow opt cap |
| 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 |
|
|
|
|
K0879 |
|
Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
| short | Pwc gp4 hd sing pow opt s/b |
| 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 |
|
|
|
|
K0880 |
|
Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds
| short | Pwc gp4 vhd sing pow opt s/b |
| 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 |
|
|
|
|
K0884 |
|
Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
| short | Pwc gp4 std mult pow opt s/b |
| 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 |
|
|
|
|
K0885 |
|
Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds
| short | Pwc gp4 std mult pow opt cap |
| 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 |
|
|
|
|
K0886 |
|
Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
| short | Pwc gp4 hd mult pow s/b |
| 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 |
|
|
|
|
K0890 |
|
Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
| short | Pwc gp5 ped sing pow opt s/b |
| 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 |
|
|
|
|
K0891 |
|
Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
| short | Pwc gp5 ped mult pow opt s/b |
| 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 |
|
|
|
|
K0898 |
|
Power wheelchair, not otherwise classified
| short | Power wheelchair noc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
K0899 |
|
Power mobility device, not coded by dme pdac or does not meet criteria
| short | Pow mobil dev no dmepdac |
| 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 | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|