HCPCS ‘K’ Codes (175)

Durable Medical Equipment For Medicare Administrative Contractors
CodeDescription
K0001Standard wheelchair
K0002Standard hemi (low seat) wheelchair
K0003Lightweight wheelchair
K0004High strength, lightweight wheelchair
K0005Ultralightweight wheelchair
K0006Heavy duty wheelchair
K0007Extra heavy duty wheelchair
K0008Custom manual wheelchair/base
K0009Other manual wheelchair/base
K0010Standard – weight frame motorized/power wheelchair
K0011Standard – weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
K0012Lightweight portable motorized/power wheelchair
K0013Custom motorized/power wheelchair base
K0014Other motorized/power wheelchair base
K0015Detachable, non-adjustable height armrest, replacement only, each
K0017Detachable, adjustable height armrest, base, replacement only, each
K0018Detachable, adjustable height armrest, upper portion, replacement only, each
K0019Arm pad, replacement only, each
K0020Fixed, adjustable height armrest, pair
K0037High mount flip-up footrest, each
K0038Leg strap, each
K0039Leg strap, h style, each
K0040Adjustable angle footplate, each
K0041Large size footplate, each
K0042Standard size footplate, replacement only, each
K0043Footrest, lower extension tube, replacement only, each
K0044Footrest, upper hanger bracket, replacement only, each
K0045Footrest, complete assembly, replacement only, each
K0046Elevating legrest, lower extension tube, replacement only, each
K0047Elevating legrest, upper hanger bracket, replacement only, each
K0050Ratchet assembly, replacement only
K0051Cam release assembly, footrest or legrest, replacement only, each
K0052Swingaway, detachable footrests, replacement only, each
K0053Elevating footrests, articulating (telescoping), each
K0056Seat height less than 17″ or equal to or greater than 21″ for a high strength, lightweight, or ultralightweight wheelchair
K0065Spoke protectors, each
K0069Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each
K0070Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each
K0071Front caster assembly, complete, with pneumatic tire, replacement only, each
K0072Front caster assembly, complete, with semi-pneumatic tire, replacement only, each
K0073Caster pin lock, each
K0077Front caster assembly, complete, with solid tire, replacement only, each
K0098Drive belt for power wheelchair, replacement only
K0105Iv hanger, each
K0108Wheelchair component or accessory, not otherwise specified
K0195Elevating leg rests, pair (for use with capped rental wheelchair base)
K0455Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol)
K0462Temporary replacement for patient owned equipment being repaired, any type
K0552Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each
K0553Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
Terminated December 31, 2022.
K0554Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system
Terminated December 31, 2022.
K0601Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each
K0602Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each
K0603Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each
K0604Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each
K0605Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each
K0606Automatic external defibrillator, with integrated electrocardiogram analysis, garment type
K0607Replacement battery for automated external defibrillator, garment type only, each
K0608Replacement garment for use with automated external defibrillator, each
K0609Replacement electrodes for use with automated external defibrillator, garment type only, each
K0669Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from dme pdac
K0672Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each
K0730Controlled dose inhalation drug delivery system
K0733Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)
K0738Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing
K0739Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes
K0740Repair or nonroutine service for oxygen equipment requiring the skill of a technician, labor component, per 15 minutes
K0743Suction pump, home model, portable, for use on wounds
K0744Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less
K0745Absorptive 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
K0746Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches
K0800Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds
K0801Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds
K0802Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds
K0806Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds
K0807Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds
K0808Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds
K0812Power operated vehicle, not otherwise classified
K0813Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds
K0814Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds
K0815Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds
K0816Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds
K0820Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0821Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds
K0822Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0823Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds
K0824Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0825Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds
K0826Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0827Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds
K0828Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more
K0829Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more
K0830Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0831Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds
K0835Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0836Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds
K0837Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0838Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds
K0839Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0840Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more
K0841Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0842Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds
K0843Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0848Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0849Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds
K0850Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0851Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds
K0852Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0853Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds
K0854Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more
K0855Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more
K0856Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0857Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds
K0858Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds
K0859Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds
K0860Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0861Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0862Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0863Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0864Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more
K0868Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0869Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds
K0870Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0871Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0877Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0878Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds
K0879Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0880Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds
K0884Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0885Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds
K0886Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0890Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
K0891Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
K0898Power wheelchair, not otherwise classified
K0899Power mobility device, not coded by dme pdac or does not meet criteria
K0900Customized durable medical equipment, other than wheelchair
K0901Knee 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.
K0902Knee 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.
K0903For 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.
K1001Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type
Terminated December 31, 2023.
K1002Cranial electrotherapy stimulation (ces) system, any type
Terminated December 31, 2023.
K1003Whirlpool tub, walk-in, portable
Terminated December 31, 2023.
K1004Low frequency ultrasonic diathermy treatment device for home use
K1005Disposable collection and storage bag for breast milk, any size, any type, each
Terminated December 31, 2023.
K1006Suction pump, home model, portable or stationary, electric, any type, for use with external urine management system
Terminated December 31, 2023.
K1007Bilateral 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
K1009Speech volume modulation system, any type, including all components and accessories
Terminated December 31, 2023.
K1010Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each
Terminated March 31, 2021.
K1011Activation device for intraurethral drainage device with valve, replacement only, each
Terminated March 31, 2021.
K1012Charger and base station for intraurethral activation device, replacement only
Terminated March 31, 2021.
K1013Enema tube, with or without adapter, any type, replacement only, each
Terminated December 31, 2023.
K1014Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control
Terminated December 31, 2023.
K1015Foot, adductus positioning device, adjustable
Terminated December 31, 2023.
K1016Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve
Terminated December 31, 2023.
K1017Monthly supplies for use of device coded at k1016
Terminated December 31, 2023.
K1018External upper limb tremor stimulator of the peripheral nerves of the wrist
Terminated December 31, 2023.
K1019Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist
Terminated December 31, 2023.
K1020Non-invasive vagus nerve stimulator
Terminated December 31, 2023.
K1021Exsufflation belt, includes all supplies and accessories
Terminated December 31, 2023.
K1022Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type
Terminated December 31, 2023.
K1023Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm
Terminated December 31, 2023.
K1024Non-pneumatic compression controller with sequential calibrated gradient pressure
Terminated December 31, 2023.
K1025Non-pneumatic sequential compression garment, full arm
Terminated December 31, 2023.
K1026Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical
Terminated December 31, 2023.
K1027Oral device/appliance used to reduce upper airway collapsibility, without fixed mechanical hinge, custom fabricated, includes fitting and adjustment
K1028Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application
Terminated December 31, 2023.
K1029Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply
Terminated December 31, 2023.
K1030External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement only
K1031Non-pneumatic compression controller without calibrated gradient pressure
Terminated December 31, 2023.
K1032Non-pneumatic sequential compression garment, full leg
Terminated December 31, 2023.
K1033Non-pneumatic sequential compression garment, half leg
Terminated December 31, 2023.
K1034Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count
K1035Molecular diagnostic test reader, nonprescription self-administered and self-collected use, fda approved, authorized or cleared
K1036Supplies and accessories (e.g., transducer) for low frequency ultrasonic diathermy treatment device, per month
K1037Docking station for use with oral device/appliance used to reduce upper airway collapsibility