MyMedi-AI

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.

StateNon-ruralRural
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
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 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

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