HCPCS 'K' Codes (165)

Durable Medical Equipment For Medicare Administrative Contractors
Code Description
K0001 Standard wheelchair
K0002 Standard hemi (low seat) wheelchair
K0003 Lightweight wheelchair
K0004 High strength, lightweight wheelchair
K0005 Ultralightweight wheelchair
K0006 Heavy duty wheelchair
K0007 Extra heavy duty wheelchair
K0008 Custom manual wheelchair/base
K0009 Other manual wheelchair/base
K0010 Standard - weight frame motorized/power wheelchair
K0011 Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
K0012 Lightweight portable motorized/power wheelchair
K0013 Custom motorized/power wheelchair base
K0014 Other motorized/power wheelchair base
K0015 Detachable, non-adjustable height armrest, replacement only, each
K0017 Detachable, adjustable height armrest, base, replacement only, each
K0018 Detachable, adjustable height armrest, upper portion, replacement only, each
K0019 Arm pad, replacement only, each
K0020 Fixed, adjustable height armrest, pair
K0037 High mount flip-up footrest, each
K0038 Leg strap, each
K0039 Leg strap, h style, each
K0040 Adjustable angle footplate, each
K0041 Large size footplate, each
K0042 Standard size footplate, replacement only, each
K0043 Footrest, lower extension tube, replacement only, each
K0044 Footrest, upper hanger bracket, replacement only, each
K0045 Footrest, complete assembly, replacement only, each
K0046 Elevating legrest, lower extension tube, replacement only, each
K0047 Elevating legrest, upper hanger bracket, replacement only, each
K0050 Ratchet assembly, replacement only
K0051 Cam release assembly, footrest or legrest, replacement only, each
K0052 Swingaway, detachable footrests, replacement only, each
K0053 Elevating footrests, articulating (telescoping), each
K0056 Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair
K0065 Spoke protectors, each
K0069 Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each
K0070 Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each
K0071 Front caster assembly, complete, with pneumatic tire, replacement only, each
K0072 Front caster assembly, complete, with semi-pneumatic tire, replacement only, each
K0073 Caster pin lock, each
K0077 Front caster assembly, complete, with solid tire, replacement only, each
K0098 Drive belt for power wheelchair, replacement only
K0105 Iv hanger, each
K0108 Wheelchair component or accessory, not otherwise specified
K0195 Elevating leg rests, pair (for use with capped rental wheelchair base)
K0455 Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol)
K0462 Temporary replacement for patient owned equipment being repaired, any type
K0552 Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each
K0553 Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
K0554 Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system
K0601 Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each
K0602 Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each
K0603 Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each
K0604 Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each
K0605 Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each
K0606 Automatic external defibrillator, with integrated electrocardiogram analysis, garment type
K0607 Replacement battery for automated external defibrillator, garment type only, each
K0608 Replacement garment for use with automated external defibrillator, each
K0609 Replacement electrodes for use with automated external defibrillator, garment type only, each
K0669 Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from dme pdac
K0672 Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each
K0730 Controlled dose inhalation drug delivery system
K0733 Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)
K0738 Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing
K0739 Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes
K0740 Repair or nonroutine service for oxygen equipment requiring the skill of a technician, labor component, per 15 minutes
K0743 Suction pump, home model, portable, for use on wounds
K0744 Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less
K0745 Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 square inches but less than or equal to 48 square inches
K0746 Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches
K0800 Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds
K0801 Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds
K0802 Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds
K0806 Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds
K0807 Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds
K0808 Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds
K0812 Power operated vehicle, not otherwise classified
K0813 Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds
K0814 Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds
K0815 Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds
K0816 Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds
K0820 Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0821 Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds
K0822 Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0823 Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds
K0824 Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0825 Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds
K0826 Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0827 Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds
K0828 Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more
K0829 Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more
K0830 Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0831 Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds
K0835 Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0836 Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds
K0837 Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0838 Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds
K0839 Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0840 Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more
K0841 Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0842 Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds
K0843 Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0848 Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0849 Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds
K0850 Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0851 Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds
K0852 Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0853 Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds
K0854 Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more
K0855 Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more
K0856 Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0857 Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds
K0858 Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds
K0859 Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds
K0860 Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0861 Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0862 Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0863 Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0864 Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more
K0868 Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0869 Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds
K0870 Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0871 Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0877 Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0878 Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds
K0879 Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0880 Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds
K0884 Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0885 Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds
K0886 Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0890 Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
K0891 Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
K0898 Power wheelchair, not otherwise classified
K0899 Power mobility device, not coded by dme pdac or does not meet criteria
K0900 Customized durable medical equipment, other than wheelchair
K0901 Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
Terminated December 31, 2016.
K0902 Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
Terminated December 31, 2016.
K0903 For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each
Terminated December 31, 2018.
K1001 Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type
K1002 Cranial electrotherapy stimulation (ces) system, includes all supplies and accessories, any type
K1003 Whirlpool tub, walk-in, portable
K1004 Low frequency ultrasonic diathermy treatment device for home use, includes all components and accessories
K1005 Disposable collection and storage bag for breast milk, any size, any type, each
K1006 Suction pump, home model, portable or stationary, electric, any type, for use with external urine management system
K1007 Bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors
K1009 Speech volume modulation system, any type, including all components and accessories
K1010 Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each
Terminated March 31, 2021.
K1011 Activation device for intraurethral drainage device with valve, replacement only, each
Terminated March 31, 2021.
K1012 Charger and base station for intraurethral activation device, replacement only
Terminated March 31, 2021.
K1013 Enema tube, with or without adapter, any type, replacement only, each
K1014 Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control
K1015 Foot, adductus positioning device, adjustable
K1016 Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve
K1017 Monthly supplies for use of device coded at k1016
K1018 External upper limb tremor stimulator of the peripheral nerves of the wrist
K1019 Monthly supplies for use of device coded at k1018
K1020 Non-invasive vagus nerve stimulator
K1021 Exsufflation belt, includes all supplies and accessories
K1022 Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type
K1023 Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm
K1024 Non-pneumatic compression controller with sequential calibrated gradient pressure
K1025 Non-pneumatic sequential compression garment, full arm
K1026 Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical
K1027 Oral device/appliance used to reduce upper airway collapsibility, without fixed mechanical hinge, custom fabricated, includes fitting and adjustment