2025 HCPCS code K0807

Power operated vehicle, group 2, heavy duty, patient weight capacity 301 to 450 pounds.

Use K0807 specifically for group 2, heavy-duty POVs intended for patients weighing between 301 and 450 pounds. Ensure documentation supports the medical necessity for the device and the patient's specific needs.Be aware of payer-specific prior authorization requirements.

Modifiers like NU (new equipment), RA (replacement), RB (replacement of a part), RR (rental), or UE (used DME) may be applicable, depending on the circumstance.Other modifiers may also apply based on specific payer rules.

Medical necessity must be established by demonstrating that the patient's mobility limitations significantly impair their ability to perform ADLs within their home. Documentation should clearly link the need for the POV to the patient's specific medical condition and functional limitations.The chosen POV should be the most appropriate and cost-effective option to meet the patient's needs.

The supplying provider (DME supplier) is responsible for ensuring the patient's suitability for the device, including their ability to safely operate and control the POV, transfer on and off, and maintain an upright position. The prescribing physician (or other qualified healthcare professional such as a PA, NP, or CNS) is responsible for evaluating the patient's medical need for the device and ordering the appropriate type and features based on the individual's specific limitations and functional needs. They also manage any required prior authorizations.

IMPORTANT For different weight capacities within group 2: K0806 (up to 300 lbs), K0808 (451 to 600 lbs).For manual wheelchairs, refer to the appropriate E&M codes for evaluation and other relevant HCPCS codes for the specific type of manual wheelchair.

In simple words: This code covers a heavy-duty motorized scooter for people weighing 301 to 450 pounds who have difficulty moving around on their own, even with canes, walkers, or regular wheelchairs.These scooters are prescribed when someone's arms aren't strong enough to use a manual wheelchair and they need help with everyday tasks at home.

This code covers the supply of a group 2 power operated vehicle (POV) for patients who cannot achieve independent movement with devices such as canes, walkers, or manual wheelchairs. This specific code is for a heavy-duty POV with a patient weight capacity of 301 to 450 pounds.POVs, also known as scooters, are medically necessary DME for patients with impaired ability to carry out activities of daily living (ADLs) such as toileting, eating, dressing, grooming, and bathing in customary locations in the home, and whose upper extremity strength is too limited to propel a manual wheelchair. A POV is a battery-operated scooter with three or four wheels.A provider prescribes scooters to patients who have sufficient ability to safely operate and control this vehicle.

Example 1: A 65-year-old patient with severe osteoarthritis in both knees and limited upper body strength requires a power operated vehicle for mobility within the home. Their weight is 350 lbs, making the K0807 the appropriate code., A 50-year-old patient with multiple sclerosis experiences significant fatigue and weakness, impacting their ability to ambulate.They weigh 400 lbs and require a heavy-duty POV (K0807) for independent mobility at home., A 70-year-old patient with post-polio syndrome has progressive muscle weakness and weighs 325 lbs.A K0807 POV is provided to enable them to perform ADLs and maintain independence within their home environment.

Documentation should include the patient's medical history, functional limitations, weight, the rationale for prescribing a POV, the specific type of POV prescribed (group 2, heavy duty), and any relevant evaluations (e.g., home assessment, physical therapy evaluation) supporting the medical necessity for the device.Prior authorization documentation, if required by the payer, should also be included.

** Prior authorization is often required for POVs under Medicare.The process may involve a face-to-face evaluation with a physician or other qualified healthcare professional, documented using G9156. It is essential to check with the DME MAC for specific prior authorization requirements.

  • Payment Status: Active
  • Specialties:Physical Medicine and Rehabilitation, Geriatrics, Neurology, Internal Medicine, Family Medicine
  • Place of Service:Home, Skilled Nursing Facility, Assisted Living Facility
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