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HCPCS K0861 · Level II · K code

K0861: Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, HCPCS Level II K code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for K0861

Medicare payment
$1,046.78
DMEPOS non-rural state fees (RR)
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
1
MAI 2
OPPS status
SI Y
Non-implantable DME
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

K0861 is a Level II code from the K section (temporary codes for DME Medicare administrative contractors), in use since 2006: "Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds". The October 2026 DMEPOS fee schedule (category CR, capped rental items) sets K0861 at RR (rental) $1,046.78 in every contiguous state (floor $889.76, ceiling $1,046.78). CMS caps K0861 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. 1 active LCD lists K0861: L33789 (Power Mobility Devices). OPPS status indicator Y: Non-implantable DME. HCPCS record: BETOS D1D (wheelchairs); pricing indicator 36; type of service A (used DME), P (lump-sum purchase of DME, prosthetics or orthotics), R (rental of DME). 55 other active codes open with "Power wheelchair"; related codes: K0848, K0835, K0825, K0823.

K0861 descriptor and code status

The October 2026 HCPCS Level II file describes K0861 as “Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds”. It sits in the K section (temporary codes for DME Medicare administrative contractors), listed with the other K codes.

HCPCS file attributes of K0861
FieldValue
Short descriptorPwc gp3 std mult pow opt s/b
Added to HCPCS2006-10-01
Last actionN (no maintenance), effective 2006-10-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator36: DMEPOS capped rental DME (floors and ceilings)
BETOS categoryD1D: wheelchairs
Type of serviceA: used DME; P: lump-sum purchase of DME, prosthetics or orthotics; R: rental of DME

Medicare payment for K0861

The October 2026 DMEPOS fee schedule (category CR, capped rental items) sets K0861 at RR (rental) $1,046.78 in every contiguous state (floor $889.76, ceiling $1,046.78). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category CR (capped rental items). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for K0861 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
RR (rental)$889.76 / $1,046.78$1,046.78 (49 states)—AK $1,046.78, HI $1,046.78, PR $1,151.47, VI $1,046.78

Hospital outpatient (OPPS Addendum B)

Status indicator Y (Non-implantable DME), with no separate OPPS payment rate.

Medically Unlikely Edits for K0861

CMS caps K0861 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. The DME supplier MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for K0861 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for K0861 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists K0861 in v323r0.

K0861 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check K0861 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for K0861

1 active Local Coverage Determination and 0 billing and coding articles list K0861. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on K0861

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists K0861

CARC 151 · N362

units of K0861 exceed the DME supplier MUE of 1 per date of service

CARC 4

the RR payment modifier is missing or does not match the item

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Prior authorization in Original Medicare

  • On the DMEPOS Required Prior Authorization List: March 20, 2017 in Illinois, Missouri, New York and West Virginia; July 17, 2017 nationwide; the DME MAC denies a claim without an affirmed request. CMS service group: Power mobility devices.

Medicare Advantage plans run their own prior authorization lists. See this code on the Medicare prior authorization list.

Where QuickIntell fits for K0861 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for K0861 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS K0861

What does HCPCS code K0861 describe?

"Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds" (short descriptor "Pwc gp3 std mult pow opt s/b"), in the K section (temporary codes for DME Medicare administrative contractors). Added 2006-10-01.

Is K0861 a CPT code?

It is not. K0861 belongs to the K section (temporary codes for DME Medicare administrative contractors) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for K0861?

The October 2026 DMEPOS fee schedule (category CR, capped rental items) sets K0861 at RR (rental) $1,046.78 in every contiguous state (floor $889.76, ceiling $1,046.78).

How many units of K0861 can be billed per day?

CMS caps K0861 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover K0861?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD lists K0861: L33789 (Power Mobility Devices).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.