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K0195 — Elevating leg rests, pair (for use with capped rental wheelchair base)

HCPCS Level II K-code · short descriptor: “Elevating whlchair leg rests”

Code system
HCPCS Level II
Family
K — DME MAC temporary codes
Medicare coverage status
Special coverage instructions apply
DMEPOS payment category
Capped rental
Prior authorization
Not on Medicare required-PA list
Status
Active (April 2026 HCPCS)

Prior authorization

Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

K0195 Medicare fee schedule (April 2026)

RR — Monthly rental Capped rental

Medicare allowable ranges from $12.39 to $22.87 depending on state and rural status.

StateNon-ruralRural
AK$22.51—
AL$13.60$20.27
AR$13.60$20.27
AZ$12.70$19.61
CA$13.98$19.95
CO$13.41$20.27
CT$13.09$18.33
DC$12.39$20.27
DE$12.39$20.27
FL$13.60$19.45
GA$13.60$20.18
HI$20.78—
IA$13.81$20.27
ID$13.41$19.00
IL$13.21$20.27
IN$13.21$20.27
KS$13.81$20.27
KY$13.60$20.27
LA$13.60$20.27
MA$13.09$18.33
MD$12.39$19.82
ME$13.09$18.33
MI$13.21$19.99
MN$13.81$20.27
MO$13.81$20.27
MS$13.60$19.18
MT$13.41$19.79
NC$13.60$20.27
ND$13.81$20.27
NE$13.81$20.27
NH$13.09$18.33
NJ$12.39$18.33
NM$12.70$19.02
NV$13.98$19.90
NY$12.39$18.33
OH$13.21$20.27
OK$12.70$20.27
OR$13.98$20.27
PA$12.39$20.27
PR$22.87—
RI$13.09$18.33
SC$13.60$20.06
SD$13.81$20.27
TN$13.60$19.75
TX$12.70$20.27
UT$13.41$20.07
VA$13.60$18.33
VI$20.27—
VT$13.09$19.73
WA$13.98$20.27
WI$13.21$20.27
WV$13.60$20.09
WY$13.41$20.27

RR + KE — Monthly rental Capped rental

Medicare allowable ranges from $19.92 to $25.12 depending on state and rural status.

StateNon-ruralRural
AK$24.72—
AL—$22.15
AR—$22.15
AZ—$21.39
CA—$21.78
CO—$22.15
CT—$19.92
DC—$22.15
DE—$22.15
FL—$21.20
GA—$22.04
HI$22.73—
IA—$22.15
ID—$20.70
IL—$22.15
IN—$22.15
KS—$22.15
KY—$22.15
LA—$22.15
MA—$19.92
MD—$21.63
ME—$19.92
MI—$21.83
MN—$22.15
MO—$22.15
MS—$20.90
MT—$21.60
NC—$22.15
ND—$22.15
NE—$22.15
NH—$19.92
NJ—$19.92
NM—$20.71
NV—$21.72
NY—$19.92
OH—$22.15
OK—$22.15
OR—$22.15
PA—$22.15
PR$25.12—
RI—$19.92
SC—$21.91
SD—$22.15
TN—$21.55
TX—$22.15
UT—$21.92
VA—$19.92
VI$22.15—
VT—$21.53
WA—$22.15
WI—$22.15
WV—$21.95
WY—$22.15

RR + KU — Monthly rental Capped rental

Medicare allowable ranges from $22.01 to $31.07 depending on state and rural status.

Former-CBA payment limits: ceiling $25.89 · floor $22.01

StateNon-ruralRural
AK$30.39—
AL$25.89—
AR$25.89—
AZ$24.56—
CA$25.25—
CO$25.89—
CT$22.01—
DC$25.89—
DE$25.89—
FL$24.25—
GA$25.70—
HI$26.92—
IA$25.89—
ID$23.36—
IL$25.89—
IN$25.89—
KS$25.89—
KY$25.89—
LA$25.89—
MA$22.01—
MD$24.98—
ME$22.01—
MI$25.33—
MN$25.89—
MO$25.89—
MS$23.73—
MT$24.92—
NC$25.89—
ND$25.89—
NE$25.89—
NH$22.01—
NJ$22.01—
NM$23.39—
NV$25.15—
NY$22.01—
OH$25.89—
OK$25.89—
OR$25.89—
PA$25.89—
PR$31.07—
RI$22.01—
SC$25.48—
SD$25.89—
TN$24.82—
TX$25.89—
UT$25.50—
VA$22.01—
VI$25.89—
VT$24.79—
WA$25.89—
WI$25.89—
WV$25.54—
WY$25.89—
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026. 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.

Common denial codes to watch

CO-50 medical necessity

Related K-codes

K0105K0108

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