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.
| 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 |
Common denial codes to watch
Related K-codes
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