HCPCS code K0037 – High mount flip-up footrest

Key takeaways

HCPCS code K0037 covers one high mount flip-up footrest, billed each, as a wheelchair accessory under Medicare Part B.

Coverage sits under LCD L33792, and the wheelchair base has to be a covered item before the footrest can be billed.

CMS retired the Certificate of Medical Necessity in 2023, so a standard written order now carries the practitioner’s instruction.

The KX modifier confirms the coverage criteria are documented, and two footrests bill on two lines with one unit each.

K0195 covers elevating leg rests for a capped rental base, sold as a pair, so it never substitutes for K0037.

What HCPCS code K0037 describes

HCPCS code K0037 describes a high mount flip-up footrest, each. It is a HCPCS Level II code, so the Centers for Medicare and Medicaid Services maintains it rather than the American Medical Association. The code is active and valid for 2026.

The billing unit is each, so one unit covers one footrest. Two footrests can go on a single line with two units, or on two lines carrying the RT and LT modifiers. The modifier section below explains when each option applies.

The K-series sits within HCPCS Level II and covers durable medical equipment items not classified elsewhere in the code set.

A high mount flip-up footrest attaches to the wheelchair frame at a raised mounting point instead of the standard lower position. It pivots upward so the patient can transfer sideways without the footrest in the way.

A fixed footrest or an elevating leg rest each carry a different code.

When Medicare pays for K0037

Medicare Part B covers K0037 as a wheelchair accessory when the patient’s wheelchair base is itself covered under the durable medical equipment benefit.

Coverage decisions sit with the DME MAC for the supplier’s jurisdiction, which means Noridian Healthcare Solutions or CGS Administrators. The governing Local Coverage Determination is LCD L33792, Wheelchair Options/Accessories.

Verifying the patient’s Medicare enrollment comes first, before any K0037 claim is built.

The conditions a K0037 claim has to meet

A K0037 claim has to satisfy every condition below. The DME MAC checks them during pre-payment or post-payment review, and missing one of them is enough to deny the line.

• The patient has a covered wheelchair base, manual or power, already on file with Medicare.
• The wheelchair base is medically necessary for the patient’s condition, as documented in the medical record.
• The high mount flip-up footrest is medically necessary for this patient. A standard lower-mount footrest has to be insufficient or clinically contraindicated.
• The treating practitioner has evaluated the patient face to face and documented the need for this specific accessory.
• The supplier is enrolled in Medicare and supplies a product that meets the descriptor, meaning high mount, flip-up, billed per unit.
• All documentation is on file with the supplier before the claim goes out, per the supplier standards at 42 CFR 424.57.

Coverage does not carry over from the wheelchair base to every accessory hung off it. Each accessory code, K0037 included, needs its own documented medical necessity. A covered power wheelchair does not, on its own, justify the K-series accessories attached to it.

The documentation K0037 needs before delivery

Documentation for K0037 follows the DMEPOS written order framework, and the supplier owns it. The practitioner generates most of the paperwork, but the supplier’s file is what gets audited.

Shipping equipment before a valid written order arrives is non-compliant, whether or not the claim eventually pays.

Two rule changes matter here. CMS discontinued the Certificate of Medical Necessity and the DME Information Form for dates of service on or after January 1, 2023.

Before that, the standard written order replaced the detailed written order on January 1, 2020. A file built to the retired templates will not answer what a DME MAC asks for today.

Required documentation for K0037 now looks like this. Each item stays in the supplier’s file for audit purposes, typically for at least seven years.

• Standard written order (SWO): signed and dated by the treating practitioner before delivery. It names the beneficiary, the item, the quantity, the order date and the prescriber.
• Medical necessity documentation in the clinical record: notes explaining why this patient needs a high mount flip-up footrest. They also say why a standard lower-mount footrest will not do.
• Face-to-face evaluation notes: a record of the evaluation by the treating practitioner or a therapist, covering mobility status and accessory needs within the required timeframe.
• Proof of delivery: a delivery receipt signed by the patient or their representative. That delivery date becomes the date of service on the claim.
• Product documentation: supplier records showing the item supplied matches the K0037 descriptor, including manufacturer, model and product description.

An internal superbill capturing the HCPCS code, diagnosis codes and service details helps your own team. A DME MAC’s Additional Development Request, though, asks for the five items above.

How a K0037 claim moves from delivery to payment

Enrolled DMEPOS suppliers bill K0037 on a CMS-1500 form or its electronic equivalent, the 837P. The claim goes to the DME MAC for the state where the beneficiary lives, not the state where the supplier sits. From there it follows a predictable path.

1. The footrest is delivered and the patient or their representative signs for it. That date becomes the date of service.
2. The billing team builds the claim line with K0037, the unit count, the modifiers and a diagnosis code that supports the wheelchair.
3. The claim is transmitted to the DME MAC as an 837P, or mailed on a CMS-1500 form.
4. Front-end edits run first. Missing information and invalid modifier combinations bounce back here, before any medical review.
5. Medicare holds a clean electronic claim for 14 days before releasing payment. Paper claims wait 29 days.
6. The remittance advice returns the paid amount, or a reason code explaining the adjustment.

The fields below are the ones that decide whether the line clears those front-end edits.

Which modifier belongs on the K0037 line

Wheelchair accessory claims carry two separate families of modifiers, and confusing them produces the same denial as a wrong code. The first family tells the DME MAC where the claim stands against the coverage criteria.

The ladder below runs through that family in the order the policy applies it.

KX is the one you will reach for most. It belongs on the accessory line only when the coverage criteria in the base LCD and the criteria for K0037 are both met and documented. Appending KX without that file behind it is a compliance problem rather than a shortcut.

RT and LT sit in the second family, and they stay optional on wheelchair accessories. Append them for two footrests and you bill two separate lines with one unit each. Putting RTLT on a single line with two units is rejected as incorrect coding.

Where to find the current K0037 payment rate

Medicare payment for K0037 comes from the DMEPOS fee schedule, which varies by locality and updates every January. CMS publishes the file on its DMEPOS fee schedule page, and your DME MAC posts locality-specific amounts as well.

This reference does not print a dollar figure. A point-in-time rate goes stale the moment the schedule updates, and a stale rate is worse than none at all. Look K0037 up in the current file for your locality instead.

Medicare pays 80% of the allowed amount once the Part B deductible is met. The patient or a secondary payer covers the remaining 20%. Confirm secondary coordination before you bill, so that balance does not sit unassigned for months.

Codes suppliers confuse with K0037

K0037 sits in a group of K-series wheelchair accessory codes with similar names and different products behind them. Picking the wrong one from this group is a common source of denials.

The table maps the neighboring codes and the distinction that decides each.

K0037 or K0195? Function decides the code

These two get confused more than any other pair in the group. The products do different clinical jobs and bill on different units, so a substitution shows up under audit.

K0037 attaches at a raised mounting point and flips up, so the patient can transfer sideways without the footrest blocking the path. It is billed each. The clinical rationale is transfer access and positioning at the higher mount height.

K0195 extends the lower leg toward horizontal, usually to manage lower-extremity edema, post-surgical positioning, or a knee that will not flex. It is billed as a pair, and it applies to a capped rental base. Where the patient owns the chair, the elevating leg rest is coded E0990 instead, per leg rest.

A patient who needs both gets separate, individually documented orders for each code. Supplying an elevating leg rest does not satisfy an order written for a flip-up footrest.

Seven errors that get K0037 claims denied

K0037 denials repeat in a small number of shapes. Naming them makes each one checkable before submission rather than after.

• Missing or late written order. The standard written order has to be signed and dated before the item ships. An order that arrives after delivery leaves the claim non-compliant, even once it is finally obtained.
• Thin medical necessity documentation. Recording that the patient uses a wheelchair is not enough. The clinical record has to say why this patient needs a high mount flip-up footrest, and why a standard one falls short.
• The wrong modifier. Appending KX without documented criteria, or omitting the coverage modifier altogether, generates edits. Check the ladder above before the line goes out.
• A product that does not match the descriptor. Billing K0037 for a standard-height or non-flip-up footrest is a coding error. What ships has to be a high mount flip-up footrest.
• K0037 billed where K0195 belongs. Confusing an elevating leg rest with a flip-up footrest is a recurring miscode. Read the order and the product description before assigning the code.
• An uncovered wheelchair base. No accessory claim pays if the underlying base is not a covered Medicare item. Confirm base coverage before billing any K-series code.
• Timely filing missed. Medicare claims are generally due within one year of the date of service. A timely filing denial cannot be argued on clinical grounds.

Sorting your K0037 denials by reason code shows which of these is costing money. The reference on common denial codes explains what a DME MAC’s remittance advice is telling you. From there, each denial maps back to a specific step in the workflow.

The checks worth running before you submit

Two verifications catch most of what goes wrong, and both happen before the claim is built. Confirm the wheelchair base has an active coverage determination on file. Then confirm the product you supplied is the one K0037 describes.

For that second check, the PDAC contractor’s product classification database is the authority on which specific products map to which HCPCS code.

The CGS Medicare coding verification resource explains how to request a verification when a product is not listed. Assigning a code from a manufacturer’s marketing description is where descriptor mismatches begin.

Run this list before the claim leaves your system:

• The wheelchair base is a covered Medicare item, and that coverage is documented.
• The standard written order is signed and dated ahead of the delivery date.
• The clinical record explains why a standard lower-mount footrest is not sufficient.
• The product matches the K0037 descriptor, confirmed against the PDAC database.
• Proof of delivery is signed and filed, and its date matches the date of service.
• The coverage modifier reflects where the claim stands, per the ladder above.
• Two footrests are billed as two units on one line, or split across RT and LT lines.
• The claim sits inside the one-year timely filing window.

One more habit is worth building in. The CMS HCPCS overview lists annual additions, deletions and descriptor changes each cycle. A quick look every January confirms K0037 still reads the way your billing system stores it.

How Pabau supports the claim side of a K0037 workflow

Most of the work above lives in two places, the clinical record and the claim form. Re-keying between them is where transcription errors enter. Practice management software like Pabau holds both in one system. The codes attached to a service land on the charge line without a second pass.

Pabau’s streamlined claims management builds the claim from the record itself. ICD-10 and HCPCS lookup libraries sit behind a search icon, so a coder can confirm a descriptor without leaving the claim.

Required fields are validated before the send button unlocks, which catches missing-information rejections early. In the US, claims route through Claim.MD, with real-time eligibility checks, claim status tracking and ERA remittance posting.

That keeps eligibility, submission and remittance on one screen, rather than spread across a clearinghouse portal, a spreadsheet and the patient record. For a billing team working a long list of accessory codes, the saving is mostly in the checking.

Keep claims and clinical records in one system

Pabau builds the claim from the patient record and validates the required fields before it can be sent. In the US, Claim.MD handles eligibility checks, claim status and ERA posting.

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Conclusion

K0037 is a short line on a claim with a long chain behind it. Get the code right and you have done the easy part. The wheelchair base still has to be covered, the order still has to predate delivery, and the product still has to match the descriptor.

Two points are worth carrying away. The CMN and the DWO are gone, so a file built to those templates will not answer an Additional Development Request. And the coverage modifier makes a claim of its own. KX asserts that documentation exists, so it belongs only on a line where it does.

Holding that standard across a whole book of accessory claims is a workflow problem more than a coding one. Book a demo to see how Pabau keeps the claim, the record and the remittance in one place.

Continue your research

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