Power Operated Vehicles - DME.WC.109.A

Coverage is limited to POVs billed under HCPCS K0800, K0801, K0802, K0806, K0807, K0808 (K0812 listed without criteria) and is excluded/limited if the policy’s specific criteria are not met. Key requirements: documented limited mobility affecting MRADLs, inability to use a cane/walker/crutches or to propel a manual wheelchair, safe independent control and transfers, adequate home access/space, weight documentation for heavy (301–450 lb: K0801/K0807) or very‑heavy (451–600 lb: K0802/K0808) devices, and for group‑2 devices (K0806/K0807/K0808) documentation of a medical reason why a group‑1 device cannot be used.

"HCPCS Codes: K0800, K0801, K0802, K0806, K0807, K0808, K0812"

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