HCPCS Code Section: HCPCS K Codes

Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds Short Description: Pwc gp 4 hd seat/back Coverage Code: Carrier judgment Action Code: No …

Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds Short Description: Pwc gp 3 hd cap chair Coverage Code: Carrier judgment Action Code: …

Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds Short Description: Pwc gp 4 std cap chair Coverage Code: Carrier judgment Action …

Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds Short Description: Pwc gp 3 hd seat/back Coverage Code: Carrier judgment Action Code: No …

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 Short …

Customized durable medical equipment, other than wheelchair Short Description: Cstm dme other than wheelchr Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: …

Power mobility device, not coded by dme pdac or does not meet criteria Short Description: Pow mobil dev no dmepdac Coverage Code: Carrier judgment Action Code: No maintenance for …

Power wheelchair, not otherwise classified Short Description: Power wheelchair noc Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: October 1, 2006 Effective Date: October …

Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds Short Description: Pwc gp5 ped mult pow opt s/b Coverage …

Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds Short Description: Pwc gp5 ped sing pow opt s/b Coverage …