K0004 HCPCS code: High strength, lightweight wheelchair
K0004 is the HCPCS Level II code for high strength, lightweight wheelchair. The 2026 Medicare DMEPOS fee schedule pays $48.55 to $163.93 (RR, rental (monthly)) depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume fell 11% from 2022 to 2024 (53,813 to 47,898 services). In 2024, 902 suppliers billed Medicare for K0004 (rentals), serving 8,900 beneficiaries; New York, Illinois, Pennsylvania accounted for 25% of services. Its average fee ranks 33 of 40 K00 codes billed RR (family range $1.93–$760.44); rural fees run 100% higher.
Code details
| Field | Value |
|---|---|
| Section | K codes — Temporary codes for DME MACs |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 36 — DMEPOS: capped rental item |
| BETOS category | D1D — Wheelchairs |
| Added | 1994-01-01 |
| Last action effective | 1994-01-01 |
2026 Medicare DMEPOS fee schedule for K0004
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| RR | rental (monthly) | $48.55 | $163.93 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | RR | $124.09 | — |
| AL | RR | $57.95 | $109.91 |
| AR | RR | $57.95 | $109.91 |
| AZ | RR | $52.68 | $124.20 |
| CA | RR | $51.77 | $109.91 |
| CO | RR | $50.22 | $109.91 |
| CT | RR | $48.76 | $110.22 |
| DC | RR | $48.55 | $116.85 |
| DE | RR | $48.55 | $109.91 |
| FL | RR | $57.95 | $109.91 |
| GA | RR | $57.95 | $109.91 |
| HI | RR | $163.93 | — |
| IA | RR | $53.13 | $124.20 |
| ID | RR | $50.22 | $124.20 |
| IL | RR | $52.23 | $124.20 |
| IN | RR | $52.23 | $124.20 |
| KS | RR | $53.13 | $124.20 |
| KY | RR | $57.95 | $121.93 |
| LA | RR | $57.95 | $109.91 |
| MA | RR | $48.76 | $124.20 |
| MD | RR | $48.55 | $109.91 |
| ME | RR | $48.76 | $124.20 |
| MI | RR | $52.23 | $119.89 |
| MN | RR | $53.13 | $109.91 |
| MO | RR | $53.13 | $124.20 |
| MS | RR | $57.95 | $109.91 |
| MT | RR | $50.22 | $124.20 |
| NC | RR | $57.95 | $117.65 |
| ND | RR | $53.13 | $124.20 |
| NE | RR | $53.13 | $124.20 |
| NH | RR | $48.76 | $120.06 |
| NJ | RR | $48.55 | $110.29 |
| NM | RR | $52.68 | $124.20 |
| NV | RR | $51.77 | $124.20 |
| NY | RR | $48.55 | $124.20 |
| OH | RR | $52.23 | $109.91 |
| OK | RR | $52.68 | $124.20 |
| OR | RR | $51.77 | $109.91 |
| PA | RR | $48.55 | $120.48 |
| PR | RR | $159.23 | — |
| RI | RR | $48.76 | $124.20 |
| SC | RR | $57.95 | $124.20 |
| SD | RR | $53.13 | $124.20 |
| TN | RR | $57.95 | $124.20 |
| TX | RR | $52.68 | $124.20 |
| UT | RR | $50.22 | $124.20 |
| VA | RR | $57.95 | $109.91 |
| VI | RR | $124.20 | — |
| VT | RR | $48.76 | $124.20 |
| WA | RR | $51.77 | $124.20 |
| WI | RR | $52.23 | $123.42 |
| WV | RR | $57.95 | $116.68 |
| WY | RR | $50.22 | $124.20 |
How the K0004 fee compares
| Measure | Value |
|---|---|
| Rank among 40 K00 codes billed RR (lowest = 1) | 33 |
| Family fee range (average of state fees) | $1.93–$760.44 |
| Rural fee uplift | 99.7% |
Who bills K0004 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | 902 |
| Suppliers billing purchases | — |
| Referring clinicians | 4,719 |
| Medicare beneficiaries | 8,900 |
| States with claims | 51 |
| Share of services in top 3 states (New York, Illinois, Pennsylvania) | 25% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 1,055 | 10,029 |
| 2023 | 1,007 | 8,792 |
| 2024 | 902 | 8,900 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for K0004, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 53,813 | 10,029 | $51.73 | $37.39 |
| 2023 | 47,561 | 8,792 | $55.70 | $40.28 |
| 2024 | 47,898 | 8,900 | $51.78 | $37.82 |
States with the most K0004 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 5,099 | $29.50 |
| Illinois | 3,855 | $36.68 |
| Pennsylvania | 3,193 | $35.21 |
| California | 2,838 | $38.10 |
| Texas | 2,645 | $36.43 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Code Descriptor / CPT Instruction |
Medicare policy articles for this code
- A52497: Manual Wheelchair Bases - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A52504: Wheelchair Options/Accessories - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for K0004
- 2026-01-01: Average state fee (RR) rose 2.6%: $57.98 to $59.48
- 1994-01-01: K0004 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code K0004?
K0004 is the HCPCS Level II code for high strength, lightweight wheelchair. Short descriptor: "High strength ltwt whlchr".
How much does Medicare pay for K0004?
Under the 2026 DMEPOS fee schedule, non-rural state fees are RR (rental (monthly)): $48.55–$163.93. Rural fees can be higher.
Does Medicare cover K0004?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for K0004 change in 2026?
The average non-rural state fee for RR moved from $57.98 in 2025 to $59.48 in 2026 (+2.6%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of K0004 can be billed per day?
1 on DME suppliers (NCCI medically unlikely edits).
Related K00 codes
- K0001 — Standard wheelchair ($25.23–$53.63)
- K0002 — Standard hemi (low seat) wheelchair ($38.93–$101.05)
- K0003 — Lightweight wheelchair ($36.91–$115.29)
- K0005 — Ultralightweight wheelchair ($259.07–$2,797.90)
- K0006 — Heavy duty wheelchair ($68.77–$169.03)
- K0007 — Extra heavy duty wheelchair ($96.40–$211.59)
- K0008 — Custom manual wheelchair/base
- K0009 — Other manual wheelchair/base ($101.86–$122.26)
- K0010 — Standard - weight frame motorized/power wheelchair ($516.03–$1,144.42)
- K0011 — Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking ($641.58–$810.57)
- K0012 — Lightweight portable motorized/power wheelchair ($393.59–$543.05)
- K0013 — Custom motorized/power wheelchair base
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under K0004
- Watch K0004 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for K0004
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.