K0816 — Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds

HCPCS Level II K-code · short descriptor: “Pwc gp 1 std cap chair” · PA required

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: Required (Medicare, since 2018-09-01)
Face-to-face & WOPD: Required (Power Mobility Devices)
MUE unit limit: 1
Status: Active (HCPCS Level II October 2026)

Prior authorization

PA REQUIRED K0816 is on Medicare's DMEPOS Required Prior Authorization List (Power Mobility Devices — nationwide since 2018-09-01).

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 REQUIRED K0816 is on Medicare's Required Face-to-Face & WOPD List (Power Mobility Devices — CMS Required F2F & WOPD List — 105 items in force on 2026-10-29; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). 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.

K0816 Medicare fee schedule (October 2026)

RR — Monthly rental Capped rental

Medicare allowable ranges from $327.71 to $529.49 depending on state and rural status.

State	Non-rural	Rural
AK	$498.45	—
AL	$349.80	$498.45
AR	$349.80	$498.45
AZ	$346.05	$498.45
CA	$341.24	$498.45
CO	$342.07	$498.45
CT	$328.22	$498.45
DC	$327.71	$498.45
DE	$327.71	$498.45
FL	$349.80	$498.45
GA	$349.80	$498.45
HI	$498.45	—
IA	$353.74	$498.45
ID	$342.07	$498.45
IL	$340.01	$498.45
IN	$340.01	$498.45
KS	$353.74	$498.45
KY	$349.80	$498.45
LA	$349.80	$498.45
MA	$328.22	$498.45
MD	$327.71	$498.45
ME	$328.22	$498.45
MI	$340.01	$498.45
MN	$353.74	$498.45
MO	$353.74	$498.45
MS	$349.80	$498.45
MT	$342.07	$498.45
NC	$349.80	$498.45
ND	$353.74	$498.45
NE	$353.74	$498.45
NH	$328.22	$498.45
NJ	$327.71	$498.45
NM	$346.05	$498.45
NV	$341.24	$498.45
NY	$327.71	$498.45
OH	$340.01	$498.45
OK	$346.05	$498.45
OR	$341.24	$498.45
PA	$327.71	$498.45
PR	$529.49	—
RI	$328.22	$498.45
SC	$349.80	$498.45
SD	$353.74	$498.45
TN	$349.80	$498.45
TX	$346.05	$498.45
UT	$342.07	$498.45
VA	$349.80	$498.45
VI	$498.45	—
VT	$328.22	$498.45
WA	$341.24	$498.45
WI	$340.01	$498.45
WV	$349.80	$498.45
WY	$342.07	$498.45

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 K0816 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

CO-50 medical necessity CO-197 no prior auth CO-151 frequency/units

Bill K0816 with confidence

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