HCPCS code K0806 – Group 2 standard power operated vehicle (scooter)

Key takeaways

HCPCS Code K0806 is a Group 2 standard power operated vehicle (scooter) for patients up to 300 pounds. It is not a power wheelchair code.

LCD L33789 denies Group 2 POVs (K0806–K0808) as not reasonable and necessary, because their added capabilities are not needed in the home.

K0806 is on the CMS Required Prior Authorization List, but DME MACs provisionally non-affirm K0806 requests as not reasonable and necessary.

Medicare covers a Group 1 scooter (K0800–K0802) when the patient meets LCD criteria A through I for use in the home.

If a patient still wants a K0806 scooter, the supplier needs a valid ABN and the GA modifier, or the supplier absorbs the cost.

What is HCPCS Code K0806?

HCPCS Code K0806 is the Level II code for a Group 2 standard power operated vehicle (POV) for patients up to and including 300 pounds.

A POV is a mobility scooter: a battery-powered device with an integrated seat, tiller steering and three or four wheels. Per the CMS HCPCS overview, Level II codes cover items such as durable medical equipment that CPT does not describe.

K0806 sits in the POV family K0800–K0812, which the DME Medicare Administrative Contractors (DME MACs) govern through LCD L33789, Power Mobility Devices. Power wheelchairs use a separate range of HCPCS K codes, such as K0820 and K0848. A scooter is never billed with a power wheelchair code, or the other way round.

K0806 vs K0807 vs K0808 and the Group 1 POV codes

The POV codes split by performance group and by patient weight. Group 1 scooters are built for indoor use, while Group 2 scooters add speed, range and climbing ability. That difference decides whether Medicare pays.

K0806, K0807 and K0808 differ only in weight capacity. The LCD also sets a lower bound: the patient must weigh at least 95% of the next lower class’s capacity. A 290-pound patient can therefore qualify for a heavy-duty scooter, because 290 is above 95% of 300.

The Power Mobility Devices policy article (A52498) sets the performance floor for each group:

Those extra miles, higher speed and taller obstacle climb serve outdoor travel, not moving between rooms. That is why the LCD treats Group 2 as more than the home requires. A POV code is billable only when the PDAC has completed a written coding verification review for that model. A model without one is billed as K0899.

Put together, the six codes form a grid of three weight classes, each with one covered Group 1 code and one denied Group 2 code.

Medicare coverage criteria for a scooter (POV)

Medicare’s standard is mobility inside the home. Under LCD L33789, a POV is covered only when the patient meets every one of these criteria:

• A. A mobility limitation that significantly impairs mobility-related activities of daily living (MRADLs), such as toileting, feeding, dressing, grooming and bathing, in the home
• B. The limitation cannot be sufficiently and safely resolved with an appropriately fitted cane or walker
• C. The patient lacks the upper extremity function to self-propel an optimally configured manual wheelchair in the home during a typical day
• D. The patient can safely transfer to and from the POV, operate the tiller steering and stay posturally stable while driving it
• E. Mental and physical capabilities, such as cognition, judgment and vision, are sufficient for safe use in the home
• F. The home has adequate access between rooms, maneuvering space and surfaces for the POV
• G. The patient’s weight is within the POV’s capacity and at least 95% of the next lower class’s capacity
• H. The POV will significantly improve MRADL participation, and the patient will use it in the home
• I. The patient has not said they are unwilling to use a POV in the home

Meeting all nine criteria supports a Group 1 code such as K0800, not K0806. The LCD states that a Group 2 POV provided to the patient will be denied as not reasonable and necessary. A scooter needed only outside the home is noncovered under the policy article, whatever its group.

Required documentation before billing a POV

POV documentation follows the current power mobility device rules in LCD L33789. Every item below should be in the supplier’s file before the scooter is delivered and the claim goes out. The older Certificate of Medical Necessity and seven-element order requirements no longer appear in the LCD.

• Face-to-face encounter: The treating practitioner examines the patient within six months before the order date. The note should describe the mobility limitation and why a cane, walker or manual wheelchair is not enough. It should also confirm the patient can steer a tiller safely.
• Standard written order prior to delivery (WOPD): The supplier must receive the order for the base item before delivery. A POV delivered without a WOPD in hand is denied.
• On-site home evaluation: Before or at delivery, the supplier or practitioner evaluates the home for access, maneuvering space and surfaces. Keep the written report available on request.
• PDAC coding verification: Confirm the model appears on the PDAC product list under the code you plan to bill.
• Prior authorization decision: Record the unique tracking number (UTN) from the DME MAC’s decision letter.
• Advance Beneficiary Notice (ABN): Required before delivery if the patient chooses a Group 2 scooter such as K0806, since Medicare will deny it.
• Proof of delivery: A signed delivery record from the patient or their representative, with the delivery date.

Prior authorization requirements for K0806

K0806 is on the CMS Required Prior Authorization List as a POV code, alongside K0800–K0802, K0807 and K0808. The program runs under 42 CFR 414.234. The DME MACs note that K0806–K0808 add capabilities not needed in the home. A prior authorization request for K0806 is therefore provisionally non-affirmed as not reasonable and necessary.

For a patient who meets the coverage criteria, the workable route is a request for the matching Group 1 code. The prior authorization process runs as follows:

1. Gather documentation. Compile the face-to-face encounter note, the written order, the home evaluation and any therapy evaluations before you submit.
2. Submit to the DME MAC. Send the request to the DME MAC for the patient’s home jurisdiction through its portal or fax line.
3. Await the decision. CGS issues standard decisions by the fifth business day, within seven calendar days. A valid expedited request is answered within two business days.
4. Deliver within six months. An affirmed decision stays valid for six months. After that, the supplier submits a new request.
5. Put the UTN on the claim. A claim for a code on the required list that has no prior authorization decision is denied.

How to bill K0806: Claim steps and modifiers

Billing a clean claim for any POV starts with an active DMEPOS supplier enrollment through the National Supplier Clearinghouse. Accreditation must be current before the first claim goes out.

1. Confirm enrollment and accreditation. Check that the supplier number is active for the patient’s state.
2. Choose the code that matches the device. Bill the PDAC-verified code for the delivered model and the patient’s weight class.
3. Complete the claim. Submit on the CMS-1500 form or the 837P transaction, usually with place of service 12 (home).
4. Add the coverage modifier. Every claim line needs KX, GA, GY or GZ, or it is rejected as missing information.
5. Submit to the correct DME MAC. Claims route by the patient’s home address: Noridian for Jurisdictions A and D, CGS for B and C.

Modifiers used with K0806

Billing a K0806 upgrade with an ABN

Some patients want a Group 2 scooter for outdoor trips even though a Group 1 model meets their home needs. DME MAC supplier manuals describe an upgrade method for this case. The upgraded item (K0806) is billed with GA, and the medically necessary item (K0800) with GK and KX. Medicare then pays up to the K0800 allowable, and the patient pays the difference under the ABN. Confirm with your DME MAC how upgrade claims interact with prior authorization before you rely on it.

Medicare reimbursement for K0806

K0806 allowables are published in the CMS DMEPOS fee schedule, which CMS updates each quarter. Amounts vary by state, and many DME codes carry separate rural and non-rural rates. Look up the current file for the patient’s state rather than relying on a figure from an older article.

In practice, a K0806 claim rarely pays at the fee schedule amount, because the LCD denies Group 2 scooters. With a GA modifier and a valid ABN, the patient owes the supplier’s charge. In an upgrade claim, Medicare pays 80% of the Group 1 allowable after the Part B deductible. The patient then owes the 20% coinsurance plus the upgrade difference. Tracking that split is part of sound revenue cycle management.

ICD-10-CM diagnosis codes that support a POV

LCD L33789 does not tie scooter coverage to a list of diagnosis codes. Coverage rests on the functional findings behind the LCD’s nine criteria. A scooter suits a patient who can sit upright, transfer and steer a tiller, but cannot walk safely at home or self-propel a manual wheelchair. These diagnoses often appear on POV orders when the encounter note documents those limits:

A patient with poor trunk control, or weakness that prevents tiller steering, fails criterion D. That patient usually needs a power wheelchair assessment instead. Whatever the diagnosis, the code shows what condition exists, and the encounter note must show what it prevents at home.

Common reasons K0806 claims are denied

Most K0806 denials are predictable, because the LCD denies Group 2 scooters by design. A solid denial management process starts by sorting these causes:

• Group 2 not reasonable and necessary: The most common outcome. The LCD denies K0806 even when the patient meets every coverage criterion.
• No valid ABN: Without a signed ABN before delivery, the claim carries GZ and the supplier cannot bill the patient.
• Missing prior authorization: The claim has no UTN, or the decision was for a different code than the one billed.
• Face-to-face encounter out of window: The encounter took place more than six months before the order date.
• No written order before delivery: The supplier delivered the scooter before receiving the WOPD.
• Outside-home use only: The records show the scooter is needed only in the community, which is noncovered.
• Missing coverage modifier: A claim line with none of KX, GA, GY or GZ is rejected as missing information.
• Model not PDAC-verified: The scooter has no coding verification review under K0806 and should have been billed as K0899.

How to appeal a denied K0806 claim

A denial that applies the LCD’s Group 2 rule is rarely overturned on appeal. Appeals work best where the denial rests on a missing record, such as an absent home evaluation, or on a missing modifier. Medicare offers five levels of appeal:

1. Redetermination (DME MAC): File within 120 days of the initial determination. The MAC generally decides within 60 days.
2. Reconsideration (Qualified Independent Contractor): File within 180 days of the redetermination decision. The QIC generally decides within 60 days.
3. ALJ hearing (Office of Medicare Hearings and Appeals): File within 60 days of the QIC decision. The amount in controversy must be at least $200 in CY2026.
4. Medicare Appeals Council: File within 60 days of the ALJ decision.
5. Federal district court: File within 60 days of the Council decision. The amount in controversy must be at least $1,960 in CY2026.

At redetermination, address the stated denial reason directly with added records, such as a corrected order or a missing home evaluation. Resubmitting the same file without new evidence rarely changes the outcome.

How Pabau supports POV orders and billing

Most POV claim problems start in the ordering practice. A face-to-face note that skips tiller ability or home layout leaves the supplier with nothing to submit. So does an order dated outside the six-month window.

Pabau, the practice management platform we build, keeps the encounter note, the order and the authorization details on the same patient record. The prior authorization code and dates are tracked on the case, with a warning when one is missing. In the US, its claims software for practices sends CMS-1500 and 837P claims and runs eligibility checks through Claim.MD.

The result is a cleaner hand-off to the supplier. The dates, findings and authorization number it needs sit on one record.

Keep encounter notes, authorizations and claims together

Pabau tracks prior authorization codes and dates on the patient’s case and sends US claims as CMS-1500 or 837P through Claim.MD.

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Conclusion

K0806 is a scooter code that Medicare is built to turn down. Treat it as a patient-choice upgrade, backed by a signed ABN, rather than a covered item. For a patient who meets criteria A through I, request and bill the matching Group 1 code instead.

Get the encounter, the written order and the home evaluation right the first time, and the scooter claim has a fair chance. Book a demo to see how Pabau keeps encounter notes, authorization details and claims on one patient record.

Continue your research

Need a foundation in DME billing? Medical billing fundamentals explains the end-to-end claims process from code selection through payment posting.

Struggling with claim denials across your DME portfolio? Denial management strategies covers root-cause analysis and appeal frameworks for high-volume DME suppliers.

Want to understand what makes a claim pay first time? Submitting a clean claim breaks down every field-level requirement that separates a paid claim from a suspended one.

Billing a scooter for a heavier patient? HCPCS code K0801 covers the Group 1 heavy-duty POV for patients from 301 to 450 pounds.

Need the very heavy-duty Group 1 code? HCPCS code K0802 explains coverage and documentation for patients from 451 to 600 pounds.

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