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HCPCS
Temporary Codes For DMERCS
Wheelchair and Wheelchair Supplies
Power Wheelchairs
Group 5, pediatric
K0891
HCPCS Code K0891
Official Description
Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
Code Data Insights
Short Descr
Pwc gp5 ped mult pow opt s/b
Coverage
Carrier Priced
Pricing Indicator(s)
36 – Supplies And Surgical Dressings - Capped rental DME (price subject to floors and ceilings)
MPI
A – Not applicable, as HCPCS priced under one methodology
BETOS
D1D – Wheelchairs
TOS Code(s)
A – Used durable medical equipment (DME)
Added Date
10/1/2006
APC Status Indicator
Non-Implantable Durable Medical Equipment
MUE
0
MUE
1
OTS Orthotic
No
CCS Clinical Classification
243 - DME and supplies
Modifier Assist
BP
The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
KX
Requirements specified in the medical policy have been met
NU
New equipment
Chapter & Section Hierarchy
K0001-K1035
Temporary Codes For DMERCS
K0001-K0899
Wheelchair and Wheelchair Supplies
K0813-K0899
Power Wheelchairs
K0890-K0891
Group 5, pediatric
K0890
Pwc gp5 ped sing pow opt s/b
K0891
Pwc gp5 ped mult pow opt s/b
Personal Notes
Code History
Date
Action
Notes
2006-10-01
Added
Code added 10/1/2006