HCPCS Level II › K codes K0002 Stnd hemi (low seat) whlchrStandard hemi (low seat) wheelchair
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 0 units per day (clinical), rationale: CMS Policy Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy DME supplier: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction Medicare pricing for K0002 DMEPOS fee schedule, July 2026 (DME26-C) RR (rental), capped rental (CR): non-rural $38.93 to $54.14 in the contiguous states; $85.07 to $101.05 in AK, HI, PR and VI; rural $76.63 to $85.38 Payer policies and prior authorization for K0002 9 of 9 payer prior-auth lists that name K0002 require prior authorization or set conditions: Blue Cross and Blue Shield of New Mexico, Blue Shield of California Promise Health Plan, Humana, Medicare, Rocky Mountain Health Plans, UnitedHealthcare Community Plan.
Payer Plan State Prior auth Conditions Since Source Blue Shield of California Promise Health Plan Promise Health Plan Medi-Cal CA prior auth required Sep 1, 2026 Medi-Cal Prior Authorization List Medicare DMEPOS Master List (items potentially subject to PA) All prior auth under conditions On the Master List; PA only if CMS selects it for the Required List Jul 30, 2026 Master List of DMEPOS Items Potentially Subject to Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements Blue Cross and Blue Shield of New Mexico Turquoise Care (New Mexico Medicaid) NM prior auth required Oct 1, 2026 New Mexico Medicaid Benefit Preauthorization Procedure Code List 10/1/26 Humana Humana Healthy Horizons KY prior auth required Jan 1, 2027 please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. Humana Humana Healthy Horizons OH prior auth required Jan 1, 2027 555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list Humana Humana Healthy Horizons VA prior auth required Jan 1, 2027 Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Rocky Mountain Health Plans Rocky Mountain Medicare Advantage D-SNP CO prior auth required Feb 1, 2025 Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025 UnitedHealthcare Community Plan UnitedHealthcare Community Plan of Kentucky KY prior auth under conditions Cost over $500 Jul 1, 2026 Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026
Payer coverage policies that name K0002 K0002 appears in 4 coverage policies from Aetna, Anthem, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
Payer Policy Role in policy Reviewed Document Aetna Wheelchairs and Power Operated Vehicles (Scooters) (0271) covered if criteria are met Aug 21, 2026 payer document Anthem Wheeled Mobility Devices: Manual Wheelchairs - Standard, Heavy Duty and Lightweight (CG-DME-24) covered if criteria are met Nov 6, 2025 payer document Capital Blue Cross Manual Wheelchairs and Accessories (MP 6.059) covered if criteria are met Sep 1, 2026 payer document Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) Wheelchairs and Accessories (DME101.010)HCPCS Codes E0950, E0951, E0952, E0953, E0954, E0955, E0956, E0957, E0958, E0959, listed, no stance Jan 1, 2026 payer document
Recent prior-auth changes Jan 1, 2027: PA added, Humana Jul 1, 2026: PA removed, HealthSpring Mar 1, 2025: PA removed, Rocky Mountain Health Plans Mar 1, 2025: PA removed, Rocky Mountain Health Plans Medicaid fee-for-service Prior authorization required or conditional in CO, IL, IN, KY, LA, MA, MS, ND, NE, NY, VA, VT, WA, WV.
AZ: $841.91 (dme), effective Oct 1, 2026 CO: $437.47 (chp_plus, non-facility), effective Jul 1, 2026 FL: $569.44 (dme), effective Jul 1, 2026 IL: $67.36 (dme), effective Jan 1, 2026 IN: $41.38 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2025 KS: $37.44 (default), effective Jul 1, 2026 KY: $36.86 (dme), effective Jan 1, 2026 LA: $482.34 (dme), effective Jul 1, 2012 MD: $38.84 (dme), effective Apr 1, 2026 MS: $613.00 (comprehensive), effective Jul 1, 2026 ND: $46.80 (dme), effective Aug 1, 2026 NE: $323.24 (dme), effective Jul 1, 2026 NY: $469.97 (dme), effective Jul 1, 2026 OH: $817.38 (dme), effective Jan 1, 2017 OK: $46.32 (dme), effective Jan 1, 2026 TX: $664.42 (dmepos_tos_9_e_j_l_and_r, Medical Supplier (Dme)), effective Jul 1, 2013 VA: $403.04 (dme), effective Dec 1, 2026 VT: $704.44 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $54.14 (medical_equipment_supplies), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.