MyMedi-AI

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)
Status
Active (April 2026 HCPCS)

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 — list effective 2026-04-13, 83 items). 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 (April 2026)

RR — Monthly rental Capped rental

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

StateNon-ruralRural
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 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

Related K-codes

Bill K0816 with confidence

MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.

Start free trial   Run a CMS-0057-F readiness check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, K0816 included, and starter credits via POST /bot-marketplace/register.