HCPCS code K0807 – Group 2 heavy duty power operated vehicle

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Key takeaways

HCPCS code K0807 covers a group 2 heavy duty power operated vehicle with a patient weight capacity of 301 to 450 pounds.

Medicare requires prior authorization for K0807, so an affirmed decision and a unique tracking number have to exist before delivery.

CMS eliminated the certificate of medical necessity in 2023, so the face-to-face exam note and the written order now carry the file.

A patient above 450 pounds moves to K0808, and a device built to group 1 performance specifications bills as K0801.

Most K0807 denials trace back to a missing document rather than to a coverage exclusion.

What HCPCS code K0807 covers

HCPCS code K0807 is the Medicare billing code for a group 2 heavy duty power operated vehicle. The device must carry a patient weight capacity of 301 to 450 pounds. CMS maintains it as a permanent HCPCS Level II code, and it is billed under the Part B durable medical equipment benefit.

The weight band is what separates K0807 from the codes either side of it. A scooter for a patient at or below 300 pounds bills as K0806 in group 2. Above 450 pounds, the code moves to K0808.

Group assignment itself turns on the device’s performance specifications, verified by the Pricing, Data Analysis and Coding (PDAC) contractor. Weight then narrows the code inside the group.

How group 2 heavy duty compares with the other POV tiers

CMS splits power operated vehicles into two groups, then three weight tiers inside each group. Group 1 runs from K0800 to K0802 and reaches 600 pounds at its top tier. Group 2 runs from K0806 to K0808 across the same three weight bands.

K0807 sits in the middle tier of group 2. K0808 is the very heavy duty code above it, and K0806 is the standard code below. The grid below shows which code each weight band points to.

Choosing the wrong group or the wrong tier is an avoidable denial. The device’s PDAC-verified classification and the patient’s documented weight both have to point at the same code.

Medicare coverage and medical necessity for K0807

Medicare Part B covers power operated vehicles under the durable medical equipment benefit when specific medical necessity criteria are met. CMS also lists K0807 on the DMEPOS Master List, so documentation must substantiate every coverage criterion before the claim is filed.

A beneficiary who misses any of the criteria below will not have a covered claim, however complete the paperwork is. Checking eligibility before the device is ordered saves the back-office effort of unwinding a denial.

• Mobility limitation: A cane, walker, or manual wheelchair cannot safely address the patient’s mobility limitation.
• Weight capacity: The patient weighs 301 to 450 pounds, the band K0807 is built for.
• In-home use: The patient can use the device inside the home, which is where Medicare’s coverage rationale for POVs sits.
• Face-to-face examination: A treating physician or qualified non-physician practitioner examined the patient and documented the mobility limitation.
• Written order before delivery: A standard written order exists and reaches the supplier before the device is delivered.
• Prior authorization: K0807 is one of six power mobility device codes in Medicare’s Required Prior Authorization Program. The DME MAC must affirm the request before delivery, and the tracking number goes on the claim.
• Medicare Part B enrollment: The patient is enrolled in Part B. A Medicare Advantage plan may add its own authorization rules on top.

Prior authorization has applied nationwide to K0807 since April 13, 2022, alongside K0800, K0801, K0802, K0806, and K0808. The supplier submits the request with the supporting medical record, and the DME MAC returns an affirmed or non-affirmed decision. Delivering before an affirmed decision arrives puts the whole claim at risk.

Local Coverage Determinations issued by the DME Medicare Administrative Contractors (DME MACs) carry the controlling clinical criteria. Verify the LCD for the beneficiary’s jurisdiction before billing, because the wording on mobility documentation varies by contractor.

K0807 documentation requirements

Incomplete documentation is the largest single driver of K0807 denials. CMS expects a defined set of records to exist before the claim is submitted. Both the treating provider and the supplier have to retain them.

One document that used to sit on this list no longer does. CMS eliminated the Certificate of Medical Necessity and the DME Information Form for claims with dates of service on or after January 1, 2023. The face-to-face examination note and the standard written order now carry the medical necessity record on their own.

2026 Medicare payment rates for K0807

K0807 payment rates under Medicare Part B vary by locality. CMS updates the DMEPOS fee schedule annually, and the allowed amount in one state can differ from another after regional adjustment.

Power operated vehicles are priced from the DMEPOS fee schedule, not the physician fee schedule. Verify the current amount in the CMS DMEPOS fee schedule files at the time of submission, because third-party rate lists lag behind CMS updates.

Medicare pays 80% of the allowed amount once the Part B deductible is met. The beneficiary or a secondary payer covers the remaining 20% coinsurance.

Items supplied in a competitive bidding area may be paid at the DMEPOS Competitive Bidding Program rate instead of the fee schedule amount. Check whether the beneficiary’s zip code falls inside a competitive bidding area before you quote a figure to a patient.

Modifiers that apply to K0807

Modifiers tell the DME MAC something the code itself does not. A missing or incorrect modifier on a K0807 claim is a frequent cause of denials and payment delays.

Never put KX and GY on the same claim line. KX affirms that the LCD criteria are met, and GY says the item is not covered at all. GA and GY can appear together in specific circumstances, so check your contractor’s guidance first.

Common denial reasons for K0807 and how to avoid them

K0807 denies at a higher rate than most DMEPOS items, because CMS layers prior authorization on top of the usual power mobility documentation. Most of those denials trace back to a missing document rather than a coverage exclusion. Knowing which one is missing shortens the correction cycle.

Reading the remittance is the fastest way to tell which of these happened. The adjustment codes that come back are grouped and explained in our reference on denial codes in billing.

• Face-to-face examination missing or thin: The exam must precede the written order. Notes that list a diagnosis without functional detail are routinely rejected.
• Patient weight not documented: The record must show a measured weight of 301 to 450 pounds. A self-reported figure with no measurement date is a common audit finding.
• No affirmed prior authorization: Delivering the device before the DME MAC affirms the request leaves the claim without its unique tracking number.
• Written order predates the exam: The face-to-face examination has to fall on or before the date of the written order. An earlier order is a technical denial.
• KX modifier missing: Without KX, the DME MAC reads the LCD criteria as unconfirmed and denies or pends the claim.
• Wrong code for the device or the weight: K0807 does not cover a patient under 301 pounds. It also does not cover a device the PDAC list places in another group.
• No proof of delivery on file: The supplier must hold a signed delivery receipt before the claim goes out.

A pre-submission checklist that catches these before the claim leaves the billing department is cheaper than an appeal. Correcting a denial after adjudication adds weeks to the payment cycle.

Related HCPCS codes in the K0800 to K0812 range

The K0800 to K0812 range covers power operated vehicles under Medicare. Picking the right code means matching the device’s PDAC-verified specifications to the patient’s documented weight. The AAPC HCPCS code lookup is a quick way to read the adjacent descriptors.

K0807 and K0808 are not two ways of coding the same device. K0807 stops at 450 pounds, and K0808 begins at 451. The device also has to carry the PDAC-verified classification for the code you bill, so a K0807-class scooter billed as K0808 is an upcoding error.

K0812 is the not otherwise classified code for a POV that no other K-code describes, and it carries no group or weight tier at all. Use it only when the device genuinely fits no other code in the range.

How to bill K0807, step by step

A clean K0807 claim follows the same sequence every time, from assessment through remittance. Building that sequence into a checklist is what keeps denials down.

1. Confirm eligibility: Verify Part B enrollment and check whether a Medicare Advantage plan adds its own authorization rules. Note the beneficiary’s zip code for competitive bidding.
2. Conduct and document the face-to-face examination: The treating practitioner records the mobility limitation and the measured weight. The notes also explain why a cane, walker, or manual wheelchair will not do.
3. Issue the standard written order: The order must fall on or after the date of the exam, and it names the device or K0807 directly.
4. Submit the prior authorization request: Send the request and the supporting medical record to the DME MAC. Wait for an affirmed decision and its unique tracking number before delivery.
5. Verify the device’s PDAC coding: Confirm with the manufacturer or the Product Classification List that the product is coded K0807. The DME MACs publish coding verification guidance for suppliers.
6. Deliver and collect proof of delivery: Obtain a dated beneficiary signature on the delivery receipt and keep the original.
7. Submit the claim with the right modifiers: Include KX when the LCD criteria are met, plus NU or RR for purchase or rental. The unique tracking number goes on the claim too.
8. Work the remittance: Review the allowed amount, the adjustments, and the remark codes. Appeal or correct within the filing window.

Volume is what makes this fragile. One skipped step in a batch of forty claims surfaces weeks later on a remittance. Suppliers who track the sequence per patient tend to land a clean claim on the first pass.

How Pabau keeps the K0807 file in one place

Most suppliers assemble a K0807 file by hand. The exam note sits in the clinical system and the written order in a scanned PDF. The authorization decision is in somebody’s email, and the delivery receipt is in a folder at the front desk.

Practice management software like Pabau keeps those records against the patient rather than across four systems. Notes, signed forms, and uploaded documents attach to the patient file, so the file an auditor asks for is already assembled.

Pabau’s claims management software then submits the claim from that record and tracks what comes back. Your team sees which claims are paid, pending, or denied without opening a payer portal. A K0807 claim stops going quiet for a month at a time.

Keep every K0807 document on the patient record

Pabau stores exam notes, signed orders, and delivery receipts on the patient file, then submits and tracks the claim. Your billing team can see what is outstanding without leaving the system.

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Conclusion

K0807 is a code where the sequence matters more than the coding. Get the exam, the order, and the authorization in the right order and the claim is ordinary. Get one of them out of order and no amount of documentation saves it.

Two rules changed recently, and older billing guides still carry the old version. The certificate of medical necessity is gone, and prior authorization is mandatory nationwide. Billing from the old checklist costs a delivery you cannot invoice.

If your K0807 file lives across four systems, moving the documents onto one record does more than pushing the billing team harder. Book a demo to see how Pabau keeps the exam note, the order, and the claim on one patient record.

Continue your research

Need to understand how denial codes affect your DMEPOS claims? Denial codes in medical billing explains the most common remittance adjustment codes and how to act on them.

Looking to tighten your overall billing compliance posture? Medical billing compliance covers the regulatory framework DMEPOS suppliers need to stay audit-ready.

Want to reduce the time between claim submission and payment posting? Revenue cycle management breaks down the end-to-end process from eligibility check through final payment.

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