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

Learn more about how to properly use and bill for HCPCS code K0861 with our short guide that has a list of documentation and billing requirements.

Use Code

## **What is HCPCS code K0861?** HCPCS code K0861, which has a description of: "Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds", identifies a Group 3 Standard Power Wheelchair with Multiple Power Options, sling/solid seat/back, for patients up to 300 pounds. This is a specific category of Complex Rehabilitative Power Wheelchair (CRPW), indicating a high-level, customized device reserved for individuals with severe mobility limitations caused by specific diagnoses, such as certain neurological conditions, myopathies, or congenital skeletal deformities. The purpose of the equipment is to provide independent mobility within the home (for mobility-related activities of daily living, or MRADLs) and to accommodate complex medical needs that cannot be met by a manual wheelchair or less advanced power mobility devices. The key feature, the "multiple power option", allows the addition of power seating systems (such as power tilt, power recline, or power leg elevation), which are crucial for medical needs like pressure ulcer prevention, spasticity management, and functional positioning for tasks like self-catheterization. Do note that this wheelchair can be equipped with a non-expandable controller or upgraded to an expandable one.

## **HCPCS code K0861 documentation requirements** The documentation for K0861 is extensive due to its high cost and the medical necessity criteria for a Group 3 multiple power option chair. Key requirements, typically mandated by Medicare DME MACs, include: ### **Face-to-face (F2F) mobility examination** A physician (MD, DO) or a qualified non-physician practitioner (NP, PA, CNS) must conduct an in-person encounter with the patient within 6 months before the Written Order for the Power Mobility Device (PMD) is written as per the final rule 1713. ### **F2F documentation** The encounter note must be a detailed narrative documenting: - The patient's mobility limitation (inability to perform mobility-related activities of daily living, or MRADLs, in the home). - Why the limitation cannot be sufficiently and safely resolved by a cane, walker, or a manually propelled wheelchair. - The patient's physical and mental capacity to operate the PWC safely, or the ability of a caregiver to safely operate it. - Justification for a Group 3 PWC (mobility limitation due to a neurological condition, myopathy, or congenital skeletal deformity). - Justification for Multiple Power Options (e.g., need for power tilt/recline to prevent pressure ulcers, manage spasticity, or for self-catheterization). ### **Standard Written Order (SWO)** A complete, written order from the treating physician. ### **Specialty evaluation** A formal evaluation performed by a Physical Therapist (PT), Occupational Therapist (OT), or a physician who has specific training and experience in rehabilitation wheelchair evaluations. This professional must document the medical necessity for the Group 3 base and the multiple power options. ### **Assistive Technology Professional (ATP) involvement** The wheelchair must be provided by a supplier who employs a RESNA-certified ATP who has direct, in-person involvement in the wheelchair selection. ### **Home assessment** Documentation that the patient's home provides adequate access, maneuvering space, and surfaces for the safe operation of the PWC. ### **Detailed Product Description (DPD)** A clear description of the specific model and features being ordered. ### **Proof of delivery** Documentation proving the item was delivered to the beneficiary. ### **Prior Authorization (PA)** K0861 is one of the codes subject to Medicare Prior Authorization as a condition of payment.

## **K0861 billing requirements** For billing, K0861 must meet the following requirements: ### **Modifiers** - **RR (Rental)**: Used when billing for a rental month - **NU (New equipment)**: Used when billing for a purchase - **KX (Documentation on file)**: Certifies that all specific coverage criteria and required documentation (including the specialty evaluation and ATP involvement) are met and on file. This modifier is critical for coverage. - **BP (Purchase)**: Used to indicate the beneficiary has been informed of purchase/rental options and elected to purchase (often used with NU and KX). - **BR (Rental)**: Used to indicate the beneficiary has been informed of purchase/rental options and elected to rent (often used with RR and KX). - **GY (Item/service statutorily excluded)**: Used if the PWC is only needed for mobility outside the home, resulting in denial as a noncovered item. ### **Rental vs purchase** Group 3 power wheelchairs are classified as Complex Rehabilitative Power Wheelchairs and can be billed as either a rental or a purchase. - **Rental**: Typically a capped rental period (e.g., 13 months for Medicare), after which ownership transfers to the beneficiary. - **Purchase**: May be billed as a lump sum, often requiring the use of the NU, BP, and KX modifiers.

## **Other relevant codes** - **K0860**: Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds - **K0862**: Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds - **K0841**: Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds - **E2377**: Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue - **E1002**: Wheelchair accessory, power seating system, tilt only - **E2298**: Complex rehabilitative power wheelchair accessory, power seat elevation system, any type

Frequently asked questions

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.