K0004 — High strength, lightweight wheelchair

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)

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 K0004 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.