K0005 — Ultralightweight 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
- Inexpensive or routinely purchased
- Prior authorization
- Required from 2026-10-28 (Medicare)
- Face-to-face & WOPD
- Required from 2026-10-28 (Manual wheelchairs)
- MUE unit limit
- 1
- Status
- Active (HCPCS Level II October 2026)
Prior authorization
PA STARTS 2026-10-28 K0005 joins Medicare's DMEPOS Required Prior Authorization List for dates of service on or after 2026-10-28 (Manual Wheelchairs — CMS-6109-N, 91 FR 47972 (published 2026-07-30)).
Claims for this item without an affirmed prior-authorization decision are automatically denied (commonly surfacing as CO-197). Submit the PA request to your DME MAC with the order and supporting clinical documentation 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 K0005 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.
K0005 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $2590.67 to $2797.90 depending on state and rural status.
Former-CBA payment limits: ceiling $2634.76 · floor $2239.55
| State | Non-rural | Rural |
|---|---|---|
| AK | $2616.59 | — |
| AL | $2634.76 | — |
| AR | $2634.76 | — |
| AZ | $2590.67 | — |
| CA | $2590.67 | — |
| CO | $2634.76 | — |
| CT | $2634.76 | — |
| DC | $2634.76 | — |
| DE | $2634.76 | — |
| FL | $2634.76 | — |
| GA | $2634.76 | — |
| HI | $2797.90 | — |
| IA | $2590.67 | — |
| ID | $2590.67 | — |
| IL | $2634.76 | — |
| IN | $2634.76 | — |
| KS | $2590.67 | — |
| KY | $2634.76 | — |
| LA | $2634.76 | — |
| MA | $2634.76 | — |
| MD | $2634.76 | — |
| ME | $2634.76 | — |
| MI | $2634.76 | — |
| MN | $2634.76 | — |
| MO | $2634.76 | — |
| MS | $2634.76 | — |
| MT | $2590.67 | — |
| NC | $2634.76 | — |
| ND | $2590.67 | — |
| NE | $2590.67 | — |
| NH | $2634.76 | — |
| NJ | $2634.76 | — |
| NM | $2634.76 | — |
| NV | $2590.67 | — |
| NY | $2634.76 | — |
| OH | $2634.76 | — |
| OK | $2634.76 | — |
| OR | $2590.67 | — |
| PA | $2634.76 | — |
| PR | $2644.29 | — |
| RI | $2634.76 | — |
| SC | $2634.76 | — |
| SD | $2590.67 | — |
| TN | $2634.76 | — |
| TX | $2634.76 | — |
| UT | $2634.76 | — |
| VA | $2634.76 | — |
| VI | $2634.76 | — |
| VT | $2634.76 | — |
| WA | $2634.76 | — |
| WI | $2634.76 | — |
| WV | $2634.76 | — |
| WY | $2590.67 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $259.07 to $264.45 depending on state and rural status.
Former-CBA payment limits: ceiling $263.45 · floor $223.93
| State | Non-rural | Rural |
|---|---|---|
| AK | $259.07 | — |
| AL | $263.45 | — |
| AR | $263.45 | — |
| AZ | $259.07 | — |
| CA | $259.07 | — |
| CO | $263.45 | — |
| CT | $263.45 | — |
| DC | $263.45 | — |
| DE | $263.45 | — |
| FL | $263.45 | — |
| GA | $263.45 | — |
| HI | $259.07 | — |
| IA | $259.07 | — |
| ID | $259.07 | — |
| IL | $263.45 | — |
| IN | $263.45 | — |
| KS | $259.07 | — |
| KY | $263.45 | — |
| LA | $263.45 | — |
| MA | $263.45 | — |
| MD | $263.45 | — |
| ME | $263.45 | — |
| MI | $263.45 | — |
| MN | $263.45 | — |
| MO | $263.45 | — |
| MS | $263.45 | — |
| MT | $259.07 | — |
| NC | $263.45 | — |
| ND | $259.07 | — |
| NE | $259.07 | — |
| NH | $263.45 | — |
| NJ | $263.45 | — |
| NM | $263.45 | — |
| NV | $259.07 | — |
| NY | $263.45 | — |
| OH | $263.45 | — |
| OK | $263.45 | — |
| OR | $259.07 | — |
| PA | $263.45 | — |
| PR | $264.45 | — |
| RI | $263.45 | — |
| SC | $263.45 | — |
| SD | $259.07 | — |
| TN | $263.45 | — |
| TX | $263.45 | — |
| UT | $263.45 | — |
| VA | $263.45 | — |
| VI | $263.45 | — |
| VT | $263.45 | — |
| WA | $263.45 | — |
| WI | $263.45 | — |
| WV | $263.45 | — |
| WY | $259.07 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $1943.03 to $2098.42 depending on state and rural status.
Former-CBA payment limits: ceiling $1976.01 · floor $1679.61
| State | Non-rural | Rural |
|---|---|---|
| AK | $1962.43 | — |
| AL | $1976.01 | — |
| AR | $1976.01 | — |
| AZ | $1943.03 | — |
| CA | $1943.03 | — |
| CO | $1976.01 | — |
| CT | $1976.01 | — |
| DC | $1976.01 | — |
| DE | $1976.01 | — |
| FL | $1976.01 | — |
| GA | $1976.01 | — |
| HI | $2098.42 | — |
| IA | $1943.03 | — |
| ID | $1943.03 | — |
| IL | $1976.01 | — |
| IN | $1976.01 | — |
| KS | $1943.03 | — |
| KY | $1976.01 | — |
| LA | $1976.01 | — |
| MA | $1976.01 | — |
| MD | $1976.01 | — |
| ME | $1976.01 | — |
| MI | $1976.01 | — |
| MN | $1976.01 | — |
| MO | $1976.01 | — |
| MS | $1976.01 | — |
| MT | $1943.03 | — |
| NC | $1976.01 | — |
| ND | $1943.03 | — |
| NE | $1943.03 | — |
| NH | $1976.01 | — |
| NJ | $1976.01 | — |
| NM | $1976.01 | — |
| NV | $1943.03 | — |
| NY | $1976.01 | — |
| OH | $1976.01 | — |
| OK | $1976.01 | — |
| OR | $1943.03 | — |
| PA | $1976.01 | — |
| PR | $1983.25 | — |
| RI | $1976.01 | — |
| SC | $1976.01 | — |
| SD | $1943.03 | — |
| TN | $1976.01 | — |
| TX | $1976.01 | — |
| UT | $1976.01 | — |
| VA | $1976.01 | — |
| VI | $1976.01 | — |
| VT | $1976.01 | — |
| WA | $1976.01 | — |
| WI | $1976.01 | — |
| WV | $1976.01 | — |
| WY | $1943.03 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps K0005 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
Bill K0005 with confidence
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