K0069 — Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each
HCPCS Level II K-code · short descriptor: “Rr whl compl sol tire rep ea”
- 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
- Not on Medicare required-PA list
- Face-to-face & WOPD
- Not on the required list
- MUE unit limit
- 2
- 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))
Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
K0069 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $110.80 to $155.21 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $139.78 | — |
| AL | $115.72 | $134.69 |
| AR | $115.72 | $134.69 |
| AZ | $113.20 | $133.47 |
| CA | $110.80 | $133.47 |
| CO | $117.43 | $134.69 |
| CT | $116.52 | $134.69 |
| DC | $114.08 | $134.69 |
| DE | $114.08 | $134.69 |
| FL | $115.72 | $134.69 |
| GA | $115.72 | $134.69 |
| HI | $139.78 | — |
| IA | $113.74 | $133.47 |
| ID | $117.43 | $133.47 |
| IL | $120.77 | $134.69 |
| IN | $120.77 | $134.69 |
| KS | $113.74 | $133.47 |
| KY | $115.72 | $134.69 |
| LA | $115.72 | $134.69 |
| MA | $116.52 | $134.69 |
| MD | $114.08 | $134.69 |
| ME | $116.52 | $134.69 |
| MI | $120.77 | $134.69 |
| MN | $113.74 | $134.69 |
| MO | $113.74 | $134.69 |
| MS | $115.72 | $134.69 |
| MT | $117.43 | $133.47 |
| NC | $115.72 | $134.69 |
| ND | $113.74 | $133.47 |
| NE | $113.74 | $133.47 |
| NH | $116.52 | $134.69 |
| NJ | $114.08 | $134.69 |
| NM | $113.20 | $134.69 |
| NV | $110.80 | $133.47 |
| NY | $114.08 | $134.69 |
| OH | $120.77 | $134.69 |
| OK | $113.20 | $134.69 |
| OR | $110.80 | $133.47 |
| PA | $114.08 | $134.69 |
| PR | $155.21 | — |
| RI | $116.52 | $134.69 |
| SC | $115.72 | $134.69 |
| SD | $113.74 | $133.47 |
| TN | $115.72 | $134.69 |
| TX | $113.20 | $134.69 |
| UT | $117.43 | $134.69 |
| VA | $115.72 | $134.69 |
| VI | $141.00 | — |
| VT | $116.52 | $134.69 |
| WA | $110.80 | $133.47 |
| WI | $120.77 | $134.69 |
| WV | $115.72 | $134.69 |
| WY | $117.43 | $133.47 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $139.97 to $170.84 depending on state and rural status.
Former-CBA payment limits: ceiling $142.42 · floor $121.06
| State | Non-rural | Rural |
|---|---|---|
| AK | $139.97 | — |
| AL | $142.42 | — |
| AR | $142.42 | — |
| AZ | $139.97 | — |
| CA | $139.97 | — |
| CO | $142.42 | — |
| CT | $142.42 | — |
| DC | $142.42 | — |
| DE | $142.42 | — |
| FL | $142.42 | — |
| GA | $142.42 | — |
| HI | $139.97 | — |
| IA | $139.97 | — |
| ID | $139.97 | — |
| IL | $142.42 | — |
| IN | $142.42 | — |
| KS | $139.97 | — |
| KY | $142.42 | — |
| LA | $142.42 | — |
| MA | $142.42 | — |
| MD | $142.42 | — |
| ME | $142.42 | — |
| MI | $142.42 | — |
| MN | $142.42 | — |
| MO | $142.42 | — |
| MS | $142.42 | — |
| MT | $139.97 | — |
| NC | $142.42 | — |
| ND | $139.97 | — |
| NE | $139.97 | — |
| NH | $142.42 | — |
| NJ | $142.42 | — |
| NM | $142.42 | — |
| NV | $139.97 | — |
| NY | $142.42 | — |
| OH | $142.42 | — |
| OK | $142.42 | — |
| OR | $139.97 | — |
| PA | $142.42 | — |
| PR | $170.84 | — |
| RI | $142.42 | — |
| SC | $142.42 | — |
| SD | $139.97 | — |
| TN | $142.42 | — |
| TX | $142.42 | — |
| UT | $142.42 | — |
| VA | $142.42 | — |
| VI | $142.42 | — |
| VT | $142.42 | — |
| WA | $139.97 | — |
| WI | $142.42 | — |
| WV | $142.42 | — |
| WY | $139.97 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $11.08 to $15.52 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $13.99 | — |
| AL | $11.57 | $13.76 |
| AR | $11.57 | $13.76 |
| AZ | $11.32 | $13.36 |
| CA | $11.08 | $13.36 |
| CO | $11.74 | $13.76 |
| CT | $11.65 | $13.76 |
| DC | $11.41 | $13.76 |
| DE | $11.41 | $13.47 |
| FL | $11.57 | $13.47 |
| GA | $11.57 | $13.76 |
| HI | $13.99 | — |
| IA | $11.38 | $13.36 |
| ID | $11.74 | $13.36 |
| IL | $12.08 | $13.76 |
| IN | $12.08 | $13.76 |
| KS | $11.38 | $13.36 |
| KY | $11.57 | $13.76 |
| LA | $11.57 | $13.76 |
| MA | $11.65 | $13.76 |
| MD | $11.41 | $13.76 |
| ME | $11.65 | $13.76 |
| MI | $12.08 | $13.76 |
| MN | $11.38 | $13.76 |
| MO | $11.38 | $13.64 |
| MS | $11.57 | $13.76 |
| MT | $11.74 | $13.36 |
| NC | $11.57 | $13.67 |
| ND | $11.38 | $13.36 |
| NE | $11.38 | $13.36 |
| NH | $11.65 | $13.47 |
| NJ | $11.41 | $13.47 |
| NM | $11.32 | $13.76 |
| NV | $11.08 | $13.36 |
| NY | $11.41 | $13.47 |
| OH | $12.08 | $13.76 |
| OK | $11.32 | $13.76 |
| OR | $11.08 | $13.36 |
| PA | $11.41 | $13.47 |
| PR | $15.52 | — |
| RI | $11.65 | $13.47 |
| SC | $11.57 | $13.76 |
| SD | $11.38 | $13.36 |
| TN | $11.57 | $13.76 |
| TX | $11.32 | $13.47 |
| UT | $11.74 | $13.76 |
| VA | $11.57 | $13.76 |
| VI | $14.10 | — |
| VT | $11.65 | $13.76 |
| WA | $11.08 | $13.36 |
| WI | $12.08 | $13.76 |
| WV | $11.57 | $13.76 |
| WY | $11.74 | $13.36 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $14.01 to $17.07 depending on state and rural status.
Former-CBA payment limits: ceiling $14.83 · floor $12.61
| State | Non-rural | Rural |
|---|---|---|
| AK | $14.01 | — |
| AL | $14.83 | — |
| AR | $14.83 | — |
| AZ | $14.01 | — |
| CA | $14.01 | — |
| CO | $14.83 | — |
| CT | $14.83 | — |
| DC | $14.83 | — |
| DE | $14.24 | — |
| FL | $14.24 | — |
| GA | $14.83 | — |
| HI | $14.01 | — |
| IA | $14.01 | — |
| ID | $14.01 | — |
| IL | $14.83 | — |
| IN | $14.83 | — |
| KS | $14.01 | — |
| KY | $14.83 | — |
| LA | $14.83 | — |
| MA | $14.83 | — |
| MD | $14.83 | — |
| ME | $14.83 | — |
| MI | $14.83 | — |
| MN | $14.83 | — |
| MO | $14.59 | — |
| MS | $14.83 | — |
| MT | $14.01 | — |
| NC | $14.66 | — |
| ND | $14.01 | — |
| NE | $14.01 | — |
| NH | $14.24 | — |
| NJ | $14.24 | — |
| NM | $14.83 | — |
| NV | $14.01 | — |
| NY | $14.24 | — |
| OH | $14.83 | — |
| OK | $14.83 | — |
| OR | $14.01 | — |
| PA | $14.24 | — |
| PR | $17.07 | — |
| RI | $14.24 | — |
| SC | $14.83 | — |
| SD | $14.01 | — |
| TN | $14.83 | — |
| TX | $14.24 | — |
| UT | $14.83 | — |
| VA | $14.83 | — |
| VI | $14.24 | — |
| VT | $14.83 | — |
| WA | $14.01 | — |
| WI | $14.83 | — |
| WV | $14.83 | — |
| WY | $14.01 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $83.10 to $116.43 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $104.84 | — |
| AL | $86.79 | $101.01 |
| AR | $86.79 | $101.01 |
| AZ | $84.90 | $100.11 |
| CA | $83.10 | $100.11 |
| CO | $88.07 | $101.01 |
| CT | $87.40 | $101.01 |
| DC | $85.56 | $101.01 |
| DE | $85.56 | $101.01 |
| FL | $86.79 | $101.01 |
| GA | $86.79 | $101.01 |
| HI | $104.84 | — |
| IA | $85.31 | $100.11 |
| ID | $88.07 | $100.11 |
| IL | $90.58 | $101.01 |
| IN | $90.58 | $101.01 |
| KS | $85.31 | $100.11 |
| KY | $86.79 | $101.01 |
| LA | $86.79 | $101.01 |
| MA | $87.40 | $101.01 |
| MD | $85.56 | $101.01 |
| ME | $87.40 | $101.01 |
| MI | $90.58 | $101.01 |
| MN | $85.31 | $101.01 |
| MO | $85.31 | $101.01 |
| MS | $86.79 | $101.01 |
| MT | $88.07 | $100.11 |
| NC | $86.79 | $101.01 |
| ND | $85.31 | $100.11 |
| NE | $85.31 | $100.11 |
| NH | $87.40 | $101.01 |
| NJ | $85.56 | $101.01 |
| NM | $84.90 | $101.01 |
| NV | $83.10 | $100.11 |
| NY | $85.56 | $101.01 |
| OH | $90.58 | $101.01 |
| OK | $84.90 | $101.01 |
| OR | $83.10 | $100.11 |
| PA | $85.56 | $101.01 |
| PR | $116.43 | — |
| RI | $87.40 | $101.01 |
| SC | $86.79 | $101.01 |
| SD | $85.31 | $100.11 |
| TN | $86.79 | $101.01 |
| TX | $84.90 | $101.01 |
| UT | $88.07 | $101.01 |
| VA | $86.79 | $101.01 |
| VI | $105.74 | — |
| VT | $87.40 | $101.01 |
| WA | $83.10 | $100.11 |
| WI | $90.58 | $101.01 |
| WV | $86.79 | $101.01 |
| WY | $88.07 | $100.11 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $104.98 to $128.17 depending on state and rural status.
Former-CBA payment limits: ceiling $106.80 · floor $90.78
| State | Non-rural | Rural |
|---|---|---|
| AK | $104.98 | — |
| AL | $106.80 | — |
| AR | $106.80 | — |
| AZ | $104.98 | — |
| CA | $104.98 | — |
| CO | $106.80 | — |
| CT | $106.80 | — |
| DC | $106.80 | — |
| DE | $106.80 | — |
| FL | $106.80 | — |
| GA | $106.80 | — |
| HI | $104.98 | — |
| IA | $104.98 | — |
| ID | $104.98 | — |
| IL | $106.80 | — |
| IN | $106.80 | — |
| KS | $104.98 | — |
| KY | $106.80 | — |
| LA | $106.80 | — |
| MA | $106.80 | — |
| MD | $106.80 | — |
| ME | $106.80 | — |
| MI | $106.80 | — |
| MN | $106.80 | — |
| MO | $106.80 | — |
| MS | $106.80 | — |
| MT | $104.98 | — |
| NC | $106.80 | — |
| ND | $104.98 | — |
| NE | $104.98 | — |
| NH | $106.80 | — |
| NJ | $106.80 | — |
| NM | $106.80 | — |
| NV | $104.98 | — |
| NY | $106.80 | — |
| OH | $106.80 | — |
| OK | $106.80 | — |
| OR | $104.98 | — |
| PA | $106.80 | — |
| PR | $128.17 | — |
| RI | $106.80 | — |
| SC | $106.80 | — |
| SD | $104.98 | — |
| TN | $106.80 | — |
| TX | $106.80 | — |
| UT | $106.80 | — |
| VA | $106.80 | — |
| VI | $106.80 | — |
| VT | $106.80 | — |
| WA | $104.98 | — |
| WI | $106.80 | — |
| WV | $106.80 | — |
| WY | $104.98 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps K0069 at 2 units 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 K0069 with confidence
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