| K0001 |
Standard wheelchair |
| K0002 |
Standard hemi (low seat) wheelchair |
| K0003 |
Lightweight wheelchair |
| K0004 |
High strength, lightweight wheelchair |
| K0005 |
Ultralightweight wheelchair |
| K0006 |
Heavy duty wheelchair |
| K0007 |
Extra heavy duty wheelchair |
| K0008 |
Custom manual wheelchair/base |
| K0009 |
Other manual wheelchair/base |
| K0010 |
Standard - weight frame motorized/power wheelchair |
| K0011 |
Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking |
| K0012 |
Lightweight portable motorized/power wheelchair |
| K0013 |
Custom motorized/power wheelchair base |
| K0014 |
Other motorized/power wheelchair base |
| K0015 |
Detachable, non-adjustable height armrest, replacement only, each |
| K0017 |
Detachable, adjustable height armrest, base, replacement only, each |
| K0018 |
Detachable, adjustable height armrest, upper portion, replacement only, each |
| K0019 |
Arm pad, replacement only, each |
| K0020 |
Fixed, adjustable height armrest, pair |
| K0037 |
High mount flip-up footrest, each |
| K0038 |
Leg strap, each |
| K0039 |
Leg strap, h style, each |
| K0040 |
Adjustable angle footplate, each |
| K0041 |
Large size footplate, each |
| K0042 |
Standard size footplate, replacement only, each |
| K0043 |
Footrest, lower extension tube, replacement only, each |
| K0044 |
Footrest, upper hanger bracket, replacement only, each |
| K0045 |
Footrest, complete assembly, replacement only, each |
| K0046 |
Elevating legrest, lower extension tube, replacement only, each |
| K0047 |
Elevating legrest, upper hanger bracket, replacement only, each |
| K0050 |
Ratchet assembly, replacement only |
| K0051 |
Cam release assembly, footrest or legrest, replacement only, each |
| K0052 |
Swingaway, detachable footrests, replacement only, each |
| K0053 |
Elevating footrests, articulating (telescoping), each |
| K0056 |
Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair |
| K0065 |
Spoke protectors, each |
| K0069 |
Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each |
| K0070 |
Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each |
| K0071 |
Front caster assembly, complete, with pneumatic tire, replacement only, each |
| K0072 |
Front caster assembly, complete, with semi-pneumatic tire, replacement only, each |
| K0073 |
Caster pin lock, each |
| K0077 |
Front caster assembly, complete, with solid tire, replacement only, each |
| K0098 |
Drive belt for power wheelchair, replacement only |
| K0105 |
Iv hanger, each |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
| K0455 |
Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol) |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
| K0601 |
Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each |
| K0602 |
Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each |
| K0603 |
Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each |
| K0604 |
Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each |
| K0605 |
Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each |
| K0606 |
Automatic external defibrillator, with integrated electrocardiogram analysis, garment type |
| K0607 |
Replacement battery for automated external defibrillator, garment type only, each |
| K0608 |
Replacement garment for use with automated external defibrillator, each |
| K0609 |
Replacement electrodes for use with automated external defibrillator, garment type only, each |
| K0669 |
Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from dme pdac |
| K0672 |
Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each |
| K0730 |
Controlled dose inhalation drug delivery system |
| K0733 |
Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
| K0740 |
Repair or nonroutine service for oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
| K0743 |
Suction pump, home model, portable, for use on wounds |
| K0744 |
Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less |
| K0745 |
Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 square inches but less than or equal to 48 square inches |
| K0746 |
Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
| K0801 |
Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds |
| K0802 |
Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds |
| K0806 |
Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds |
| K0807 |
Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds |
| K0808 |
Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds |
| K0812 |
Power operated vehicle, not otherwise classified |
| K0813 |
Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds |
| K0814 |
Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
| K0815 |
Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds |
| K0816 |
Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds |
| K0820 |
Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| K0821 |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
| K0822 |
Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
| K0824 |
Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
| K0826 |
Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
| K0827 |
Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds |
| K0828 |
Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more |
| K0829 |
Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more |
| K0830 |
Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| K0831 |
Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds |
| K0835 |
Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| K0836 |
Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds |
| K0837 |
Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
| K0838 |
Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds |
| K0839 |
Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
| K0840 |
Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more |
| 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 |
| 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 |
| 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 |