K0864 — Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more
HCPCS Level II K-code · short descriptor: “Pwc gp3 xhd mult 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 2019-07-22)
- Status
- Active (April 2026 HCPCS)
Prior authorization
PA REQUIRED K0864 is on Medicare's DMEPOS Required Prior Authorization List (Power Mobility Devices — nationwide since 2019-07-22).
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.
K0864 Medicare fee schedule (April 2026)
RR — Monthly rental Capped rental
Medicare allowable ranges from $2204.42 to $2424.90 depending on state and rural status.
Former-CBA payment limits: ceiling $2204.42 · floor $1873.76
| State | Non-rural | Rural |
|---|---|---|
| AK | $2204.42 | — |
| AL | $2204.42 | — |
| AR | $2204.42 | — |
| AZ | $2204.42 | — |
| CA | $2204.42 | — |
| CO | $2204.42 | — |
| CT | $2204.42 | — |
| DC | $2204.42 | — |
| DE | $2204.42 | — |
| FL | $2204.42 | — |
| GA | $2204.42 | — |
| HI | $2204.42 | — |
| IA | $2204.42 | — |
| ID | $2204.42 | — |
| IL | $2204.42 | — |
| IN | $2204.42 | — |
| KS | $2204.42 | — |
| KY | $2204.42 | — |
| LA | $2204.42 | — |
| MA | $2204.42 | — |
| MD | $2204.42 | — |
| ME | $2204.42 | — |
| MI | $2204.42 | — |
| MN | $2204.42 | — |
| MO | $2204.42 | — |
| MS | $2204.42 | — |
| MT | $2204.42 | — |
| NC | $2204.42 | — |
| ND | $2204.42 | — |
| NE | $2204.42 | — |
| NH | $2204.42 | — |
| NJ | $2204.42 | — |
| NM | $2204.42 | — |
| NV | $2204.42 | — |
| NY | $2204.42 | — |
| OH | $2204.42 | — |
| OK | $2204.42 | — |
| OR | $2204.42 | — |
| PA | $2204.42 | — |
| PR | $2424.90 | — |
| RI | $2204.42 | — |
| SC | $2204.42 | — |
| SD | $2204.42 | — |
| TN | $2204.42 | — |
| TX | $2204.42 | — |
| UT | $2204.42 | — |
| VA | $2204.42 | — |
| VI | $2204.42 | — |
| VT | $2204.42 | — |
| WA | $2204.42 | — |
| WI | $2204.42 | — |
| WV | $2204.42 | — |
| WY | $2204.42 | — |
Common denial codes to watch
Related K-codes
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