HCPCS K0861: Power hWeelchair, Group 3 Standard, Multiple Power Option, Sling/Solid Seat/Back

Yes, K0861 is a complex rehabilitative power wheelchair code and is subject to the Medicare Prior Authorization (PA) process as a condition of payment. Submitting a claim without a required PA approval will result in a denial.

Generally, the reimbursement for the K0861 base includes a basic, weight-appropriate sling/solid seat and back. However, a separate, therapeutic skin protection and/or positioning seat or back cushion that meets specific coverage criteria (e.g., to prevent pressure ulcers) may be billed separately because K0861 is a base that does not have a Captain's Chair (non-custom) seating system.

Group 3 PWCs (like K0861) are required when the mobility limitation is specifically due to a severe neurological condition, myopathy, or congenital skeletal deformity and the patient requires features like multiple power options or a non-standard drive control interface. Group 2 PWCs are for patients who can't use a manual chair or scooter but don't meet the specific, more stringent Group 3 medical necessity criteria.