MyMedi-AI

K0851 — Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds

HCPCS Level II K-code · short descriptor: “Pwc gp 3 hd 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 K0851 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 K0851 is on Medicare's Required Face-to-Face & WOPD List (Power Mobility Devices — 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)). 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.

K0851 Medicare fee schedule (October 2026)

RR — Monthly rental Capped rental

Medicare allowable ranges from $1085.92 to $1194.54 depending on state and rural status.

Former-CBA payment limits: ceiling $1085.92 · floor $923.03

StateNon-ruralRural
AK$1085.92—
AL$1085.92—
AR$1085.92—
AZ$1085.92—
CA$1085.92—
CO$1085.92—
CT$1085.92—
DC$1085.92—
DE$1085.92—
FL$1085.92—
GA$1085.92—
HI$1085.92—
IA$1085.92—
ID$1085.92—
IL$1085.92—
IN$1085.92—
KS$1085.92—
KY$1085.92—
LA$1085.92—
MA$1085.92—
MD$1085.92—
ME$1085.92—
MI$1085.92—
MN$1085.92—
MO$1085.92—
MS$1085.92—
MT$1085.92—
NC$1085.92—
ND$1085.92—
NE$1085.92—
NH$1085.92—
NJ$1085.92—
NM$1085.92—
NV$1085.92—
NY$1085.92—
OH$1085.92—
OK$1085.92—
OR$1085.92—
PA$1085.92—
PR$1194.54—
RI$1085.92—
SC$1085.92—
SD$1085.92—
TN$1085.92—
TX$1085.92—
UT$1085.92—
VA$1085.92—
VI$1085.92—
VT$1085.92—
WA$1085.92—
WI$1085.92—
WV$1085.92—
WY$1085.92—
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 K0851 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

Related K-codes

Bill K0851 with confidence

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