K0007 — Extra heavy duty 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 K0007 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.
K0007 Medicare fee schedule (October 2026)
RR — Monthly rental Capped rental
Medicare allowable ranges from $96.40 to $211.59 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $208.53 | — |
| AL | $120.78 | $186.65 |
| AR | $120.78 | $187.58 |
| AZ | $104.16 | $178.08 |
| CA | $115.15 | $181.18 |
| CO | $111.57 | $187.58 |
| CT | $96.40 | $187.58 |
| DC | $101.06 | $187.58 |
| DE | $101.06 | $186.25 |
| FL | $120.78 | $178.42 |
| GA | $120.78 | $185.46 |
| HI | $208.53 | — |
| IA | $102.07 | $187.58 |
| ID | $111.57 | $187.58 |
| IL | $109.44 | $187.58 |
| IN | $109.44 | $187.58 |
| KS | $102.07 | $187.58 |
| KY | $120.78 | $187.58 |
| LA | $120.78 | $187.05 |
| MA | $96.40 | $187.58 |
| MD | $101.06 | $182.01 |
| ME | $96.40 | $187.58 |
| MI | $109.44 | $183.71 |
| MN | $102.07 | $187.58 |
| MO | $102.07 | $187.58 |
| MS | $120.78 | $175.93 |
| MT | $111.57 | $174.73 |
| NC | $120.78 | $187.58 |
| ND | $102.07 | $168.50 |
| NE | $102.07 | $187.58 |
| NH | $96.40 | $187.58 |
| NJ | $101.06 | $181.39 |
| NM | $104.16 | $174.34 |
| NV | $115.15 | $180.90 |
| NY | $101.06 | $185.43 |
| OH | $109.44 | $187.58 |
| OK | $104.16 | $187.58 |
| OR | $115.15 | $187.58 |
| PA | $101.06 | $183.97 |
| PR | $211.59 | — |
| RI | $96.40 | $168.50 |
| SC | $120.78 | $184.57 |
| SD | $102.07 | $184.73 |
| TN | $120.78 | $181.27 |
| TX | $104.16 | $187.58 |
| UT | $111.57 | $187.58 |
| VA | $120.78 | $182.11 |
| VI | $185.43 | — |
| VT | $96.40 | $187.58 |
| WA | $115.15 | $187.58 |
| WI | $109.44 | $187.58 |
| WV | $120.78 | $184.97 |
| WY | $111.57 | $184.33 |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps K0007 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 K0007 with confidence
Track prior-authorization requests with AI pre-fill and deadline tracking, and draft PA appeal letters — built for DME teams, PHI-free: no patient data is collected or stored.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →
Building an AI agent? Try the agent API in the playground — free PA-required lookups, K0007 included, and starter credits via POST /bot-marketplace/register.