MyMedi-AI

K0856 — Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

HCPCS Level II K-code · short descriptor: “Pwc gp3 std sing pow opt s/b” · 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 2017-07-17)
Face-to-face & WOPD
Required (Power Mobility Devices)
MUE unit limit
1
Status
Active (HCPCS Level II October 2026)

Prior authorization

PA REQUIRED K0856 is on Medicare's DMEPOS Required Prior Authorization List (Power Mobility Devices — nationwide since 2017-07-17).

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 K0856 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.

K0856 Medicare fee schedule (October 2026)

RR — Monthly rental Capped rental

Medicare allowable ranges from $1045.09 to $1149.63 depending on state and rural status.

Former-CBA payment limits: ceiling $1045.09 · floor $888.33

StateNon-ruralRural
AK$1045.09—
AL$1045.09—
AR$1045.09—
AZ$1045.09—
CA$1045.09—
CO$1045.09—
CT$1045.09—
DC$1045.09—
DE$1045.09—
FL$1045.09—
GA$1045.09—
HI$1045.09—
IA$1045.09—
ID$1045.09—
IL$1045.09—
IN$1045.09—
KS$1045.09—
KY$1045.09—
LA$1045.09—
MA$1045.09—
MD$1045.09—
ME$1045.09—
MI$1045.09—
MN$1045.09—
MO$1045.09—
MS$1045.09—
MT$1045.09—
NC$1045.09—
ND$1045.09—
NE$1045.09—
NH$1045.09—
NJ$1045.09—
NM$1045.09—
NV$1045.09—
NY$1045.09—
OH$1045.09—
OK$1045.09—
OR$1045.09—
PA$1045.09—
PR$1149.63—
RI$1045.09—
SC$1045.09—
SD$1045.09—
TN$1045.09—
TX$1045.09—
UT$1045.09—
VA$1045.09—
VI$1045.09—
VT$1045.09—
WA$1045.09—
WI$1045.09—
WV$1045.09—
WY$1045.09—
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 K0856 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 K0856 with confidence

Track prior-authorization requests with AI pre-fill and deadline tracking, and draft PA appeal letters — built for DME teams, PHI-free: no patient data is collected or stored.

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, K0856 included, and starter credits via POST /bot-marketplace/register.