2025 HCPCS code K0891
(Active) Effective Date: N/A Revision Date: N/A Durable Medical Equipment - Power Wheelchairs Durable Medical Equipment (DME) Feed
Supply of a group 5 pediatric power wheelchair with multiple power options, sling or solid seat and back; weight capacity up to 125 pounds.
Modifiers may be applicable depending on the circumstances of service (e.g., GA, GY, GZ, KX, etc.). Consult with your payer's guidelines for specific modifier applications.
Medical necessity requires documentation demonstrating that the patient cannot achieve independent mobility using other assistive devices (canes, walkers, manual wheelchairs) and that a power wheelchair is essential for their participation in activities of daily living, school, and/or community activities.The documentation should address the patient's ability to safely operate, transfer to and from, and maintain an upright position in the wheelchair.
The provider must document a direct face-to-face encounter with the patient and the medical condition necessitating the power wheelchair.This includes assessing the patient's ability to safely operate the wheelchair, transfer to and from it, and maintain an upright position while using it.
In simple words: This code pays for a special electric wheelchair for kids who weigh 125 pounds or less. It has extra features and a comfortable seat. The doctor must see the child in person to determine if this wheelchair is needed.Medicare only covers it if the doctor says it's medically necessary.
This HCPCS code covers the supply of a group 5 pediatric power wheelchair featuring multiple power options and a sling-style or solid seat and back.The wheelchair's weight capacity is up to and including 125 pounds.This code is appropriate for children who cannot achieve independent mobility using devices like canes, walkers, or manual wheelchairs.The provider must document a face-to-face encounter and the medical necessity for the power wheelchair.Medicare covers the supply of DME only if medically necessary.
Example 1: A 10-year-old child with cerebral palsy requiring a power wheelchair for mobility due to significant motor impairments. The wheelchair needs multiple power options for navigating various terrains., An 8-year-old child with muscular dystrophy whose muscle weakness prevents independent mobility with other assistive devices. A power wheelchair with a sling seat is necessary for proper support., A child with spina bifida who has limited lower extremity function and requires a power wheelchair to participate in school and social activities. The wheelchair needs specific adjustments for their individual needs and a solid seat for support.
Documentation must include a physician's face-to-face encounter, assessment of the patient's mobility limitations, medical necessity justification for the power wheelchair, and the patient's ability to safely operate the device.
** Group 5 pediatric power wheelchairs are categorized based on factors like dimensions, obstacle maneuverability, speed, range, and stability.Always verify the specific requirements of the payer for prior authorization.
- Payment Status: Active
- Specialties:Pediatric, Physical Medicine and Rehabilitation, Orthopedics
- Place of Service:Office, Home