Cracking the Codes: Manual Wheelchair Definitions



Ultralightweight manual wheelchairs, used by clients with so many different diagnoses and needs, are covered by a single code. But the current K0005 HCPCS code isn’t just alone. It’s also old.

Rita Stanley, VP of Government Relations for Sunrise Medical, said, “It is important to note that the manual wheelchair K codes were established in 1993.”

Back then, Stanley said, “Ultralightweight wheelchairs were quite new and represented the first meaningful and revolutionary change for full-time manual wheelchair users. There were only a handful of manufacturers and models. Motion Designs, later Quickie Designs and now Sunrise Medical, was one of the original manufacturers of ultralightweight wheelchairs. Ultralightweight technology was revolutionary and changed the lives of people with disabilities who depended on manual wheelchairs for their mobility.”

There was plenty of cause to be excited, Stanley added: “The features that created the initial excitement was the weight of the wheelchair (T6 aluminum versus steel) and the ability to position the propulsion wheel, which meant the wheel could be positioned for proper and effective upper-extremity propulsion.”

Stanley said DMERC Medical Directors consulted industry representatives to develop definitions for the new codes and to determine how many codes should be established. “As one might expect,” she said, “there were significantly more standard wheelchairs on the market at the time than ultralightweight wheelchairs. In addition, evidence was scarce at that time to prove the importance of the ultralightweight wheelchair technology.”

Weighty Definitions

By definition, HCPCS K codes are temporary codes, but “there is no defined limit on how long a K code can be maintained,” Stanley pointed out. “The code descriptor has remained essentially the same since 1993.”

For the Ultralightweight K0005 chair, that descriptor is:
Weight: Less than 30 lbs.
Adjustable rear axle position
Lifetime warranty on side frames and cross braces

“In the beginning,” Stanley said, “the K0005 was defined as including seat widths and depths 14", 16", and 18"; 12" and 20" were billable on K0005 classified wheelchairs.

“Today, however, if a wheelchair is less than 15" in width or depth, it is classified as a pediatric wheelchair, even though it is being provided to an adult.”

The K0001 through K0004 codes are defined as follows:

Standard wheelchair (K0001)
Weight: Greater than 36 lbs.
Seat Height: 19" or greater
Weight capacity: 250 lbs. or less

Standard hemi (low seat) wheelchair (K0002)
Weight: Greater than 36 lbs.
Seat Height: Less than 19 inches
Weight capacity: 250 lbs. or less

Lightweight wheelchair (K0003)
Weight: 34-36 lbs.
Weight capacity: 250 lbs. or less

High-strength, lightweight wheelchair (K0004)
Weight: Less than 34 lbs.
Lifetime Warranty on side frames and cross braces

The “weight” in these descriptors is the weight of the wheelchair itself without the front rigging (but with all other components included) as in the case of the K0001, K0002, K0003, K0004, and K0005, Stanley said.

Evolving Understanding of Ultralights

“As you see, the code differences are primarily based on the weight of the wheelchair,” she explained.

“Current research indicates that [for] performance and function of manual wheelchairs, especially for a person with a disability who is a full-time user, the wheelchair configuration is critical,” Stanley said. “The technological differences between K0005 and all other manual wheelchairs — other than those that offer tilt-in-space — vary significantly. The code requirements only establish the minimum requirements. The actual capabilities, features and options available on K0005 wheelchairs vary greatly. Unfortunately, reimbursement often limits the models that are available under third-party reimbursement.”

Stanley added that while once upon a time, K0004 products offered some higher-level functions, that’s rarely the case now.

“Prior to [Medicare] competitive bidding, it wasn’t uncommon to find K0004-coded wheelchairs that offered additional features and limited adjustability,” she said. “Today, few K0004 models remain on the market that offer additional features, and none would be available based on the current third-party reimbursement.”

This article originally appeared in the June 2019 issue of Mobility Management.

Referrals and Prescriptions podcast