2025 HCPCS code K0843

Heavy duty group 2 power wheelchair with multiple power options, sling/solid seat and back, for patients weighing 301-450 lbs.

Follow HCPCS coding guidelines and Medicare guidelines for DME. Ensure proper documentation for medical necessity. Contact the DME MAC for prior authorization requirements.

Modifiers such as RR (rental) or BP/BU (purchase options) may be applicable. Refer to HCPCS modifier guidelines for details.

Medical necessity must be established by demonstrating that the patient's condition significantly impairs their mobility to the extent that a power wheelchair is required for basic activities of daily living. Documentation should support the chosen power wheelchair group and features (e.g., heavy-duty, multiple power options) based on the patient's specific needs and abilities.

The supplying provider (physician, physician assistant, nurse practitioner, or clinical nurse specialist) is responsible for documenting the face-to-face encounter, medical necessity, patient's ability to safely operate the wheelchair, transfer, and maintain an upright position.They may also be responsible for submitting prior authorization requests if required by the DME MAC.

In simple words: This code covers a heavy-duty electric wheelchair for people weighing between 301 and 450 pounds. It has different power settings and a sling or solid seat.A doctor needs to see the patient and document why they need this specific type of wheelchair.

This code covers a heavy-duty, group 2 power wheelchair with multiple power options, featuring either a sling or solid seat and back, designed for patients with a weight capacity of 301 to 450 pounds.It is intended for patients with impaired mobility who cannot independently use canes, walkers, or manual wheelchairs.The wheelchair is battery-operated and suitable for individuals with limited upper extremity strength who are unable to propel a manual wheelchair.Documentation of a face-to-face encounter and medical necessity is required.

Example 1: A 400-pound patient with multiple sclerosis experiences significant fatigue and decreased upper extremity strength, making it impossible to use a manual wheelchair.K0843 is used for the provision of a power wheelchair., A 350-pound patient post-stroke has limited mobility and requires a power wheelchair. K0843 is billed for the appropriate chair that can support patient and provide multiple power options., A 325-pound patient with amyotrophic lateral sclerosis (ALS) requires a heavy-duty power wheelchair with multiple power options as their condition progresses. K0843 would be appropriate given the patient's weight and need for a power wheelchair with different power settings.

Documentation must include face-to-face evaluation, medical necessity for a power wheelchair, patient's weight, assessment of the patient's ability for safe operation, transfer, and upright positioning. Prior authorization documentation (if required) should also be included.

** Prior authorization is often required for power wheelchairs.Check with the patient's DME MAC.The code G9156 can be billed for the evaluation for a wheelchair requiring a face-to-face visit.

  • Payment Status: Active
  • Specialties:Physical Medicine and Rehabilitation, Neurology, Geriatrics, Internal Medicine
  • Place of Service:Patient's Home, Skilled Nursing Facility, Inpatient Hospital (if provided during an inpatient stay and intended for use post-discharge), and others as appropriate.
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