HCPCS code K0828 – Group 2 extra heavy duty power wheelchair, 601 lb or more

Key takeaways

HCPCS Code K0828 is a group 2 extra heavy duty power wheelchair with a sling/solid seat and back, rated for 601 pounds or more.

Its captain’s chair twin is K0829, while K0826 and K0827 cover the very heavy duty band of 451 to 600 pounds.

Medicare covers K0828 under LCD L33789 when the general power wheelchair criteria are met and the beneficiary weighs 570 pounds or more.

K0828 is on the Required Prior Authorization List and needs a face-to-face encounter and a written order before delivery.

In Pabau’s claims software, the prior authorization code follows the order to the claim, and a claim missing it is flagged before submission.

HCPCS Code K0828: Official descriptor and code details

HCPCS Code K0828 describes a power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more.

It is a base power wheelchair with no power seating options, built for the heaviest weight band in the Group 2 range. It sits in the K0813 to K0899 power wheelchair range of the HCPCS Level II codes.

Each part of the descriptor narrows the code. “Group 2” is the performance tier above Group 1. “Extra heavy duty” sets the capacity at 601 pounds or more. “Sling/solid seat/back” separates K0828 from K0829, which carries a captain’s chair instead. A chair at this capacity with one power seating option moves to K0840.

K0828 is a Level II HCPCS code maintained by CMS under the HCPCS coding system. It is billed to the DME MAC (Durable Medical Equipment Medicare Administrative Contractor) for the beneficiary’s state of residence. Two DME MACs cover the four jurisdictions: Noridian for Jurisdictions A and D, and CGS Administrators for Jurisdictions B and C.

Medicare coverage criteria for K0828

Medicare covers HCPCS Code K0828 under the Part B DME benefit when the beneficiary meets every criterion in LCD L33789, Power Mobility Devices. The criteria are cumulative, and each one must be documented in the medical record:

• The beneficiary has a mobility limitation that significantly impairs mobility-related activities of daily living (MRADLs) in the home, such as toileting, dressing or bathing.
• An appropriately fitted cane or walker cannot safely resolve the limitation.
• The beneficiary lacks the upper extremity function to self-propel an optimally configured manual wheelchair.
• A power-operated vehicle (scooter) does not meet the beneficiary’s needs.
• The beneficiary can safely operate the power wheelchair, or has a caregiver who can.
• The home allows adequate access between rooms, maneuvering space and suitable surfaces for the chair.
• The chair will significantly improve the beneficiary’s MRADLs, and the beneficiary will use it in the home.

On top of those criteria, the chair must suit the beneficiary’s weight. The LCD covers an extra heavy duty power wheelchair for a beneficiary weighing 570 pounds or more. That threshold sits below the 601-pound capacity in the K0828 descriptor, so record the measured weight rather than an estimate.

K0828 is a Group 2 base chair with no power options. Single and multiple power option chairs and Group 3 chairs need a specialty evaluation by a physical or occupational therapist. Their supplier must also employ a RESNA-certified ATP. Neither requirement applies to K0828.

Required documentation for K0828 claims

Three items must be in place before a K0828 chair is delivered: the face-to-face encounter note, the written order and the prior authorization decision. The home assessment and proof of delivery complete the file.

Face-to-face encounter and written order prior to delivery

The treating practitioner must hold a face-to-face encounter within six months before the order date. The note must describe the mobility limitation, why a cane, walker, manual wheelchair or scooter will not work, and the beneficiary’s weight. A routine office visit note that skips these elements will not support the claim.

K0828 also needs a written order prior to delivery (WOPD). It is a standard written order that the supplier must hold before the chair is delivered. The order lists the beneficiary’s name or Medicare Beneficiary Identifier, the order date, the item, the quantity, and the practitioner’s name or NPI and signature.

No Certificate of Medical Necessity is filed for K0828. CMS removed the CMN requirement for power mobility devices in 2006, and LCD L33789 relies on the written order and the medical record instead.

Home assessment and proof of delivery

Before or at delivery, the supplier or practitioner must complete an on-site evaluation of the home. The written report must be available to the DME MAC on request. It should confirm the chair fits through doorways and turns within the rooms where the beneficiary needs it.

Keeping a complete file supports medical billing compliance at every step. Suppliers must keep proof of delivery for seven years, and the same file should hold the encounter note, the order and the home assessment.

Supporting ICD-10 diagnosis codes for K0828

Every K0828 claim needs ICD-10-CM codes that explain the mobility limitation and the weight. For a Group 2 base chair, LCD L33789 sets functional and weight criteria rather than limiting coverage to named diagnoses. The codes still have to match what the face-to-face note documents. An obesity code such as E66.01, paired with a Z68 BMI code, covers the weight side of the claim.

Code to the highest specificity the record supports, and check each code against the current ICD-10-CM release before filing. AAPC’s K0828 entry can help confirm the descriptor while you build the claim.

Prior authorization requirements for K0828

Medicare requires prior authorization for HCPCS Code K0828. It has been on the CMS Required Prior Authorization List nationwide since September 1, 2018. The power mobility codes on that list cover scooters and Group 1, 2 and 3 power wheelchairs, not Groups 4 and 5.

The prior authorization process works as follows:

1. The supplier collects the face-to-face encounter note, the written order and the records that support each LCD criterion, including the measured weight.
2. The request goes to the DME MAC for the beneficiary’s jurisdiction before the chair is delivered.
3. The DME MAC sends its decision by the fifth business day after receipt. An expedited request gets a decision within about two business days when the need is valid.
4. A provisional affirmation comes with a unique tracking number (UTN) for the claim. It stays valid for six months, and a chair not delivered by then needs a new request.
5. A non-affirmed request can be corrected and resubmitted. The non-affirmation itself cannot be appealed, though a denied claim can be.

Verifying insurance eligibility before the request confirms that Part B is active. It also shows whether the beneficiary is in traditional Medicare or a Medicare Advantage plan, which sets its own prior authorization rules.

K0828 vs. neighboring power wheelchair codes

Two facts pick the code within this family: the weight band and the seat type. K0828 and K0829 share the 601-pound-plus capacity. K0828 has a sling/solid seat and back, and K0829 has a captain’s chair.

K0826 and K0827 are the very heavy duty pair, rated for 451 to 600 pounds. K0839 is the very heavy duty chair with one power option, and K0840 is its extra heavy duty counterpart. K0830 is a different chair altogether: a group 2 standard base with a seat elevator, rated up to 300 pounds.

Bill the code the PDAC lists for the base that was delivered, not the one that was ordered. In February 2026 the DME MACs also proposed treating K0830 and K0831 as not reasonable and necessary. Check the final LCD before billing either.

Billing HCPCS Code K0828: Step-by-step claim submission

A clean K0828 claim depends on the order of events. Each step below must be complete before the next one starts.

1. Confirm beneficiary eligibility: Check Part B coverage and confirm the beneficiary is in traditional Medicare.
2. Hold the face-to-face encounter: The treating practitioner documents the mobility limitation and measured weight within six months before the order date.
3. Receive the written order: The supplier holds the standard written order before delivery.
4. Match the base to the code: Confirm the PDAC lists the chair’s base as K0828.
5. Request prior authorization: Send the full package to the DME MAC and get a provisional affirmation and UTN.
6. Assess the home and deliver: Complete the on-site evaluation, deliver within six months of the affirmation and get signed proof of delivery.
7. Submit the claim: File on the CMS-1500 or 837P with the UTN, the ICD-10-CM codes, the supplier NPI and the modifiers below.

K0828 is a capped rental item, and Medicare requires standard power wheelchairs to be rented. Each monthly claim carries these modifiers:

• RR: The item is rented.
• KH, KI or KJ: KH for the first rental month, KI for months two and three, and KJ for months four to 13.
• KX: Every LCD coverage criterion is met and documented. Leave it off when one is not met.

Put together, the pre-delivery deadlines and the rental modifiers run on one timeline, from the encounter to the 13th month.

Suppliers billing HCPCS Code K0828 must be accredited and enrolled as a DMEPOS supplier under 42 CFR 424.57. Since November 2022, the National Provider Enrollment (NPE) contractors have handled that enrollment in place of the National Supplier Clearinghouse. Integrated claims management software that tracks each K0828 order’s documents reduces submission errors and keeps an audit trail.

Common reasons HCPCS Code K0828 claims are denied

A K0828 claim must satisfy prior authorization, the face-to-face rule, the written order rule and the LCD at once. A defect in any one of them is enough for a denial.

Appealing a denied K0828 claim

Medicare has a five-level appeal process for denied K0828 claims. The first level is a redetermination request to the DME MAC within 120 days of the initial determination. If it is upheld, the supplier can ask a Qualified Independent Contractor (QIC) for reconsideration within 180 days.

Later levels are an Administrative Law Judge hearing, the Medicare Appeals Council and federal district court. New evidence at each level, such as a clarifying practitioner letter, strengthens the appeal. Understanding the full denial management process before filing improves the odds of reversal at the earlier levels.

Local coverage determinations governing K0828

LCD L33789, “Power Mobility Devices,” is the coverage policy for HCPCS Code K0828 in all four DME MAC jurisdictions. Noridian and CGS publish the same LCD, so the K0828 criteria do not change by state. Each DME MAC may still publish its own billing guidance and policy articles.

The version in force applies to services on or after October 1, 2025. In February 2026 the DME MACs published a proposed revision for comment. Search the CMS Medicare Coverage Database for L33789 and its policy article. Check the effective date before citing either in an authorization request or appeal.

Medicare reimbursement rates for K0828

Medicare pays for K0828 as a capped rental. It pays a monthly rental for up to 13 continuous months, after which ownership passes to the beneficiary. Medicare pays 80 percent of the allowed amount after the Part B deductible, and the beneficiary owes 20 percent.

Allowed amounts come from the CMS DMEPOS fee schedule, which is updated each year and varies by state. Where a competitive bidding contract covers the beneficiary’s area, the contract price applies instead. Confirm the current rate before quoting a figure for K0828.

How Pabau keeps K0828 authorizations and claims together

A K0828 order runs on dates. The encounter, the written order, the authorization decision and the delivery must fall in sequence, and the UTN must reach every rental claim.

Pabau, the practice management platform we build, stores each prior authorization as a case. Attach the case when booking, and its authorization code follows through to the claim. A claim still missing a code is flagged with “Assign case” before it goes out.

Claim validation checks each CMS-1500 claim for missing or invalid details before it leaves Pabau. Claims go out through Claim.MD, and eligibility checks run before the visit, so you know which payer’s rules apply.

Each insurer payment is recorded once and matched to the invoices it covers. Across 13 rental months, that shows which K0828 claims are paid and which need action.

Keep power wheelchair claims authorization-ready

Pabau stores each prior authorization as a case and carries its code onto the claim. Claim validation flags missing details before a K0828 claim reaches the DME MAC.

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Conclusion

K0828 turns on two documented facts: a weight of 570 pounds or more and a chair with a sling/solid seat and back. When both hold, K0828 is the code. When either differs, K0829, K0826 or K0840 fits the claim better.

The payment then depends on order. Hold the encounter note, the written order and the affirmation before delivery, and bill each rental month with the UTN and the right modifiers. Book a demo to see how Pabau keeps authorization codes attached to every power wheelchair claim.

Continue your research

Billing the same family one weight band down? HCPCS Code K0827 covers the Group 2 very heavy duty chair with a captain’s chair, rated for 451 to 600 pounds.

Is the chair fitted with one power seating option? HCPCS Code K0839 covers the Group 2 very heavy duty chair with a single power option, rated for 451 to 600 pounds.

Need a primer on clean claim requirements? What is medical billing explains the end-to-end billing workflow from patient encounter to paid claim.

Struggling with high denial rates across your DME billing? Denial management in healthcare covers the appeals process and prevention strategies for common payer rejections.

Want to improve documentation accuracy before submission? Medical billing compliance outlines the documentation retention and audit-readiness requirements that protect suppliers during DME MAC reviews.

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