MyMedi-AI

K0003 — Lightweight wheelchair

HCPCS Level II K-code

Code system
HCPCS Level II
Family
K — DME MAC temporary codes
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
Capped rental
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Required from 2026-10-28 (Manual wheelchairs)
MUE unit limit
1
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

F2F + WOPD FROM 2026-10-28 K0003 joins Medicare's Required Face-to-Face & WOPD List for dates of service on or after 2026-10-28 (Manual wheelchairs — CMS-6109-N, 91 FR 47972 (published 2026-07-30)). From that date two extra conditions of payment apply:

  • Face-to-face encounter (in-person or telehealth) with the treating practitioner within the 6 months before the order date
  • Written order communicated to the supplier before delivery (WOPD)

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

K0003 Medicare fee schedule (October 2026)

RR — Monthly rental Capped rental

Medicare allowable ranges from $36.91 to $115.29 depending on state and rural status.

StateNon-ruralRural
AK$115.29—
AL$46.99$87.36
AR$46.99$87.36
AZ$44.42$79.43
CA$41.97$79.56
CO$41.47$87.36
CT$37.55$87.36
DC$36.91$86.67
DE$36.91$77.78
FL$46.99$77.78
GA$46.99$86.55
HI$84.62—
IA$44.90$87.36
ID$41.47$77.78
IL$43.47$87.36
IN$43.47$85.87
KS$44.90$87.36
KY$46.99$77.78
LA$46.99$87.36
MA$37.55$87.36
MD$36.91$80.99
ME$37.55$87.36
MI$43.47$78.78
MN$44.90$86.17
MO$44.90$86.65
MS$46.99$77.78
MT$41.47$87.36
NC$46.99$77.78
ND$44.90$82.14
NE$44.90$87.36
NH$37.55$86.77
NJ$36.91$87.36
NM$44.42$87.36
NV$41.97$80.36
NY$36.91$80.69
OH$43.47$87.36
OK$44.42$85.55
OR$41.97$85.19
PA$36.91$87.36
PR$88.22—
RI$37.55$77.78
SC$46.99$87.36
SD$44.90$87.36
TN$46.99$87.36
TX$44.42$87.36
UT$41.47$87.36
VA$46.99$87.36
VI$80.69—
VT$37.55$87.36
WA$41.97$87.36
WI$43.47$79.04
WV$46.99$87.36
WY$41.47$87.17
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps K0003 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Code Descriptor / CPT Instruction.

Common denial codes to watch

Related K-codes

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