2025 HCPCS code K0890
Pediatric power wheelchair, group 5, single power option, sling or solid seat/back, patient weight capacity up to and including 125 lbs.
Modifiers may be applicable. Refer to current HCPCS guidelines.
Medicare covers DME like power wheelchairs only when deemed medically necessary by the prescribing physician. This means the equipment must be required for the child's treatment or to improve their ability to perform daily activities.
The supplier (DME provider) is responsible for ensuring the wheelchair is medically necessary and appropriate for the child. The prescribing physician must document a face-to-face encounter and the medical reason for the power wheelchair. The supplier must also ensure the child can safely operate the wheelchair and transfer to and from it.
In simple words: This code covers a powered wheelchair specifically designed for children weighing up to 125 pounds, who are unable to move around on their own using canes, walkers, or regular wheelchairs. It's a power wheelchair with only one power setting and has a simple sling or solid seat and back.
This code covers the supply of a group 5 pediatric power wheelchair with a single power option, sling or solid seat and back, for patients weighing up to 125 pounds. These wheelchairs are for children who cannot achieve independent movement with other mobility aids.
Example 1: A 10-year-old child with cerebral palsy requires a power wheelchair for mobility at school and home. The child weighs under 125 lbs and is able to independently operate the wheelchair controls., A 12-year-old child with spina bifida needs a power wheelchair to participate in community activities. The child weighs 110 lbs and has sufficient upper body strength to control the wheelchair safely. , A 9-year-old with muscular dystrophy requires a power wheelchair with a sling seat for increased postural support. The child weighs 95 lbs and can operate the single-power option controls independently.
Documentation should include the child's medical condition, functional limitations, inability to use alternative mobility devices, the medical necessity for a power wheelchair, face-to-face evaluation, and the child's ability to safely operate the wheelchair.
- Payment Status: Active
- Specialties:Pediatrics, Physical Medicine and Rehabilitation, Orthopedics
- Place of Service:Patient's Home, School, Inpatient Hospital (if used during inpatient stay), etc.