HCPCS Code Section: HCPCS K Codes

Standard – weight frame motorized/power wheelchair Short Description: Stnd wt frame power whlchr Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 1994 …

Other manual wheelchair/base Short Description: Other manual wheelchair/base Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 1994 Effective Date: July 1, 2013 …

Large size footplate, each Short Description: Large size footplate each Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 1994 Effective Date: January …

Custom manual wheelchair/base Short Description: Cstm manual wheelchair/base Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: July 1, 2013 Effective Date: July …

Front caster assembly, complete, with pneumatic tire, replacement only, each Short Description: Fr cstr comp pne tire rep ea Coverage Code: Carrier judgment Action Code: No maintenance for this …

Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each Short Description: Rr whl compl pne tire rep ea Coverage Code: Carrier judgment Action Code: No …

Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each Short Description: Rr whl compl sol tire rep ea Coverage Code: Carrier judgment Action Code: No …

Spoke protectors, each Short Description: Spoke protectors Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 1994 Effective Date: January 1, 2000 Termination …

Seat height less than 17″ or equal to or greater than 21″ for a high strength, lightweight, or ultralightweight wheelchair Short Description: Seat ht =21 ltwt wc Coverage Code: …

Elevating footrests, articulating (telescoping), each Short Description: Elevate footrest articulate Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 1994 Effective Date: January …