2025 HCPCS code K0839
Power wheelchair, group 2 very heavy duty, single power option sling/solid seat/back, patient weight capacity 451 to 600 pounds.
Modifiers such as BP (Beneficiary has been informed of purchase and rental options and has elected to purchase), BU (Beneficiary has not informed supplier of decision after 30 days), RR (Rental), and others may apply depending on the specific payer and circumstances.
Medicare covers DME like power wheelchairs when deemed medically necessary by the provider. Prior authorization may be required.
The provider (physician, physician assistant, nurse practitioner, or clinical nurse specialist) must conduct a face-to-face evaluation, document the medical necessity for the power wheelchair, and ensure the patient is capable of safe and independent operation of the device, safe transfer, and self-support in an upright position.
In simple words: This code covers a very heavy-duty electric wheelchair designed for people weighing between 451 and 600 pounds. It has a single power option and either a sling or solid seat and back.
This code covers the supply of a very heavy-duty group 2 power wheelchair with a single power option, sling/solid seat and back, and a patient weight capacity of 451 to 600 pounds. It is used for patients who have impaired ability to carry out activities of daily living, are unable to walk, and whose upper extremity strength is too limited to propel a manual wheelchair. The provider must document a direct face-to-face encounter and the medical necessity for the power wheelchair.
Example 1: A 500-pound patient with severe osteoarthritis and limited upper extremity strength requires a power wheelchair for mobility and independence in daily activities., A 550-pound patient with post-polio syndrome requires a heavy-duty power wheelchair to navigate their home and community., A 480-pound patient with morbid obesity and limited mobility needs a power wheelchair for transportation and participation in daily routines.
Documentation should include the face-to-face evaluation, medical necessity justification for the power wheelchair, patient's weight and mobility limitations, assessment of the patient's ability to safely operate and transfer, and any other relevant clinical information supporting the need for the device.
** Prior authorization may be required. G9156 can be billed for the evaluation for a wheelchair requiring a face-to-face visit. Power wheelchairs are classified into groups based on various parameters like size, maneuverability, speed, and stability. Group 2 PWCs are larger and more robust than group 1.
- Payment Status: Active
- Specialties:Physical Medicine and Rehabilitation, Internal Medicine, Geriatrics, Neurology
- Place of Service:Patient's Home, Skilled Nursing Facility, Nursing Facility, Inpatient Hospital, Office, and other applicable places of service.