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See a sample rate comparisonHCPCS K0816 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds
| Key Fact | Detail |
|---|---|
| Service Type | Durable medical equipment (DME) Medicare administrative contractors (MACs) Wheelchairs, Power Operated |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for K0816 |
National average reimbursement for HCPCS K0816 by major payers:
$2,171.14
$1,846.74
$1,958.98
$4,082.67
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HCPCS K0816
5 of 25 sample ratesHigher to lower in this preview
Christopher Raio
Samaritan Emergency Medical Services PC
$2,143.00Published rateBrittany Ptachick
Hroa 401k Plan
$1,608.92Published rateChristopher Raio
St Joseph Hospital
$321.45Published rateMichael Jacobson
Hroa 401k Plan
$241.34Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$115.72Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS K0816 vs. Other Wheelchairs, Power Operated Codes
The HCPCS K0816 code is part of the Durable medical equipment (DME) Medicare administrative contractors (MACs) services used for Wheelchairs, Power Operated. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS K0816 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| K0815-HCPCS | High | Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds |
| K0816-HCPCS | High | Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds |
| K0820-HCPCS | High | Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS K0816. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the K0816 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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