DME & Supplies codes K0001 to K0864 with Medicaid rates by state

107 dme & supplies codes from K0001 to K0864 carry a published Medicaid rate in ten or more states. The median shown is across those states' unmodified published rates; open a code for the full state-by-state table with percent of Medicare and prior-authorization flags.

CodeDescriptionStatesMedian rate
K0001Standard wheelchair43$264.47
K0002Standard hemi (low seat) wheelchair42$453.54
K0003Lightweight wheelchair42$394.10
K0004High strength, lightweight wheelchair44$531.30
K0005Ultralightweight wheelchair45$2,165.10
K0006Heavy duty wheelchair42$718.15
K0007Extra heavy duty wheelchair42$960.60
K0009Other manual wheelchair/base27$922.02
K0010Standard - weight frame motorized/power wheelchair30$3,575.29
K0011Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking29$4,214.68
K0012Lightweight portable motorized/power wheelchair28$2,623.71
K0015Detachable, non-adjustable height armrest, replacement only, each42$155.04
K0017Detachable, adjustable height armrest, base, replacement only, each43$49.43
K0018Detachable, adjustable height armrest, upper portion, replacement only, each43$27.77
K0019Arm pad, replacement only, each43$15.34
K0020Fixed, adjustable height armrest, pair42$45.66
K0037High mount flip-up footrest, each41$45.71
K0038Leg strap, each43$23.93
K0039Leg strap, h style, each42$52.98
K0040Adjustable angle footplate, each43$64.60
K0041Large size footplate, each42$50.82
K0042Standard size footplate, replacement only, each42$34.03
K0043Footrest, lower extension tube, replacement only, each43$19.37
K0044Footrest, upper hanger bracket, replacement only, each42$16.61
K0045Footrest, complete assembly, replacement only, each43$54.81
K0046Elevating legrest, lower extension tube, replacement only, each41$19.51
K0047Elevating legrest, upper hanger bracket, replacement only, each43$72.39
K0050Ratchet assembly, replacement only41$32.05
K0051Cam release assembly, footrest or legrest, replacement only, each41$51.96
K0052Swingaway, detachable footrests, replacement only, each42$83.67
K0053Elevating footrests, articulating (telescoping), each41$94.30
K0056Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair45$96.05
K0065Spoke protectors, each44$44.41
K0069Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each42$98.62
K0070Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each43$173.09
K0071Front caster assembly, complete, with pneumatic tire, replacement only, each44$106.30
K0072Front caster assembly, complete, with semi-pneumatic tire, replacement only, each44$65.31
K0073Caster pin lock, each45$34.91
K0077Front caster assembly, complete, with solid tire, replacement only, each44$57.52
K0098Drive belt for power wheelchair, replacement only37$25.88
K0105Iv hanger, each43$98.14
K0195Elevating leg rests, pair (for use with capped rental wheelchair base)36$138.10
K0455Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol)21$377.46
K0552Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each29$2.81
K0601Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each30$1.34
K0602Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each29$7.65
K0603Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each30$0.68
K0604Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each29$7.36
K0605Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each27$17.38
K0606Automatic external defibrillator, with integrated electrocardiogram analysis, garment type40$2,694.70
K0607Replacement battery for automated external defibrillator, garment type only, each21$228.43
K0608Replacement garment for use with automated external defibrillator, each18$138.24
K0609Replacement electrodes for use with automated external defibrillator, garment type only, each19$905.19
K0672Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each30$82.38
K0730Controlled dose inhalation drug delivery system27$1,959.42
K0733Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)41$30.00
K0738Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing33$43.29
K0739Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes42$17.52
K0740Repair or nonroutine service for oxygen equipment requiring the skill of a technician, labor component, per 15 minutes17$13.41
K0800Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds37$1,008.17
K0801Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds38$1,776.73
K0802Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds37$2,153.78
K0806Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds34$1,428.06
K0807Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds33$2,168.21
K0808Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds33$3,352.67
K0813Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds37$2,132.21
K0814Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds38$2,352.47
K0815Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds39$2,800.31
K0816Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds39$2,662.34
K0820Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds38$2,192.58
K0821Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds38$2,426.17
K0822Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds40$2,966.09
K0823Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds41$2,358.26
K0824Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds41$3,757.33
K0825Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds41$3,399.86
K0826Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds39$6,295.27
K0827Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds40$5,371.07
K0828Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more40$6,850.65
K0829Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more40$6,287.28
K0830Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds25$3,346.57
K0831Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds24$3,804.87
K0835Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds41$3,191.59
K0836Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds40$3,172.74
K0837Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds40$3,842.27
K0838Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds39$3,405.53
K0839Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds38$5,231.44
K0840Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more39$7,880.81
K0841Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds41$3,616.11
K0842Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds40$3,370.93
K0843Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds41$4,174.94
K0848Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds41$5,663.89
K0849Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds41$5,330.68
K0850Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds41$6,431.34
K0851Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds41$6,183.84
K0852Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds41$7,431.05
K0853Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds41$7,797.90
K0854Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more40$9,526.02
K0855Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more40$9,285.44
K0856Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds41$6,079.41
K0857Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds39$6,184.01
K0858Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds41$7,383.94
K0859Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds40$7,193.59
K0860Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds41$10,806.02
K0861Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds42$6,250.00
K0862Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds41$7,542.83
K0863Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds40$11,208.17
K0864Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more40$12,318.84

Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.