VERZIHEALTHGet a key
Coverage Knowledge Base

Every policy word on this page is CMS's own. Verzi adds pins, receipts, and links only.

K0077

Wheelchair Options/Accessories

LCD L33792 · CMS's HCPCS descriptor for K0077: Front caster assembly, complete, with solid tire, replacement only, each.

Not on CMS's Required Prior Authorization List for DMEPOS on 2026-10-13. source

LCD L33792 · 26 versions, 2015 to today · last changed 2025-10-01 (R13)

Version 8 of LCD L33792: in force by CMS's dates 2016-01-01 to 2015-12-31. The policy text on this page comes from this archived version. On its start date, 2016-01-01, the companion Article in force was Article A52504 version 5.

DME MAC jurisdictions
JA · Noridian 16013
CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI, VT
JB · CGS 17013
IL, IN, KY, MI, MN, OH, WI
JC · CGS 18003
AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC, TN, TX, VI, VA, WV
JD · Noridian 19003
AK, AS, AZ, CA, GU, HI, ID, IA, KS, MO, MT, NE, NV, ND, MP, OR, SD, UT, WA, WY
source

CMS's Who are the MACs jurisdiction pages (DME facts as of 2025-09-30) name each contractor and its states; the MCD's Contractor Information table on every DME LCD prints the contract numbers. Both read 2026-10-09. Verzi adds the state lookup only.

You are viewing version 8 (2016-01-01, superseded same day). Version 43 is in force today.

Codes CMS lists in this LCD's current version (version 43, 164 codes). CMS's download carries no list for version 8: A9270 A9900 E0705 E0950 E0951 E0952 E0954 E0958 E0959 E0961 E0967 E0971 E0973 E0974 E0978 E0981 E0982 E0985 E0988 E0990 E0995 E1002 E1003 E1004
140 more codes
E1005 E1006 E1007 E1008 E1009 E1010 E1011 E1012 E1014 E1015 E1016 E1017 E1018 E1020 E1022 E1023 E1028 E1029 E1030 E1032 E1225 E1226 E2201 E2202 E2203 E2204 E2205 E2206 E2207 E2208 E2209 E2210 E2211 E2212 E2213 E2214 E2215 E2216 E2217 E2218 E2219 E2220 E2221 E2222 E2224 E2225 E2226 E2227 E2228 E2230 E2295 E2298 E2301 E2310 E2311 E2312 E2313 E2321 E2322 E2323 E2324 E2325 E2326 E2327 E2328 E2329 E2330 E2331 E2351 E2358 E2359 E2360 E2361 E2362 E2363 E2364 E2365 E2366 E2367 E2368 E2369 E2370 E2371 E2372 E2373 E2374 E2375 E2376 E2377 E2378 E2381 E2382 E2383 E2384 E2385 E2386 E2387 E2388 E2389 E2390 E2391 E2392 E2394 E2395 E2396 E2397 E2398 K0015 K0017 K0018 K0019 K0020 K0037 K0038 K0039 K0040 K0041 K0042 K0043 K0044 K0045 K0046 K0047 K0050 K0051 K0052 K0053 K0056 K0065 K0069 K0070 K0071 K0072 K0073 K0077 K0098 K0105 K0108 K0195 K0733

Sections in this version: CMS National Coverage Policy · Coverage Indications, Limitations, and/or Medical Necessity · Coding Information · Associated Information · Sources of Information and Basis for Decision. Plus 3 sections marked N/A in this version.

Full verbatim text serves to customers · Customer? Log in

Version history, LCD L33792

CMS numbers each version. Each box shows the version's window by CMS's stated dates. Select a version to show it on this page. Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask. Version numbers CMS never published to its archive do not exist as documents.

v22015-10-01, superseded same dayv22015-10-01, superseded same dayv42015-10-01, superseded same dayv42015-10-01, superseded same dayv52015-10-01, superseded same dayv52015-10-01 to 2015-12-31v82016-01-01, superseded same dayv82016-01-01 to 2016-06-30v92016-07-01, superseded same dayv92016-07-01 to 2016-12-31v142017-01-01, superseded same dayv142017-01-01 to 2017-12-31v162018-01-01, superseded same dayv162018-01-01 to 2018-12-31v202019-01-01, superseded same dayv202019-01-01 to 2019-12-31v222020-01-01, superseded same dayv222020-01-01, superseded same dayv282020-01-01, superseded same dayv282020-01-01 to 2023-05-15v312023-05-16, superseded same dayv312023-05-16 to 2024-03-31v362024-04-01, superseded same dayv362024-04-01 to 2025-03-31v412025-04-01 to 2025-09-30v432025-10-01 to today

Revision history, every version

CMS's own change log, quoted, 24 entries. It does not change with the version shown. A revision (R-number) is a change CMS logged. The version (vN) is the snapshot that carries it.

R13 · 2025-10-01 · v43
Revision Effective Date: 10/01/2025
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: “For information concerning a push-rim activated power assist device for a manual wheelchair, refer to the Power Mobility Devices medical policy.” to “For information concerning a power assist system for a manual wheelchair, refer to the Power Mobility Devices medical policy.”
10/30/2025: Pursuant to the 21st Century Cures Act, this revision does not require notice and comment because the revision is non-substantive to align with information in the Power Mobility Devices medical policy.
R12 · 2025-04-01 · v41
Revision Effective Date: 04/01/2025
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: HCPCS noted as swingaway, retractable, or removable hardware, from “(E1028)” to “(E1028, E1032)”
HCPCS CODES:
Revised: Long description for HCPCS code E1028
Revised: Long description for HCPCS code E1005, for dates of service on or after January 1, 2004
Added: HCPCS codes E1022, E1023, and E1032 to Group 9 Codes
04/03/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.
R11 · 2024-04-01 · v36
Revision Effective Date: 04/01/2024
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Removed: “(E2300)” from language pertaining to power seat elevation systems
Added: “(E2298)” to language pertaining to power seat elevation systems
HCPCS CODES:
Removed: E2300 from Group 6 Codes
Added: E2298 to Group 6 Codes
05/02/2024: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.
R11 · 2024-04-01 · v36
Revision Effective Date: 04/01/2024
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Removed: “(E2300)” from language pertaining to power seat elevation systems
Added: “(E2298)” to language pertaining to power seat elevation systems
HCPCS CODES:
Removed: E2300 from Group 6 Codes
Added: E2298 to Group 6 Codes
05/02/2024: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.
R10 · 2023-05-16 · v31
Revision Effective Date: 05/16/2023
CMS NATIONAL COVERAGE POLICY:
Added: "280.16"
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: Coverage information for the power seat elevation system (E2300) when the beneficiary meets coverage criteria for either a Group 2 single power option or multiple power option power-driven wheelchair, or a Group 3 power-driven wheelchair
and
meets the coverage criteria for seat elevation equipment as described in the National Coverage Determination (NCD) 280.16.
08/17/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates due to development of National Coverage Determination (NCD) 280.16.
R10 · 2023-05-16 · v31
Revision Effective Date: 05/16/2023
CMS NATIONAL COVERAGE POLICY:
Added: "280.16"
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: Coverage information for the power seat elevation system (E2300) when the beneficiary meets coverage criteria for either a Group 2 single power option or multiple power option power-driven wheelchair, or a Group 3 power-driven wheelchair
and
meets the coverage criteria for seat elevation equipment as described in the National Coverage Determination (NCD) 280.16.
08/17/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates due to development of National Coverage Determination (NCD) 280.16.
R9 · 2020-01-01 · v28
Revision Effective Date: 01/01/2020
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed HCPCS
Revised: "physician" to "practitioner"
Revised: Order information as a result of Final Rule 1713
CODING INFORMATION:
Removed: Field titled “Bill Type”
Removed: Field titled “Revenue Codes”
Removed: Field titled “ICD-10 Codes that Support Medical Necessity”
Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity”
Removed: Field titled “Additional ICD-10 Information”
DOCUMENTATION REQUIREMENTS:
Revised: “physician’s” to “treating practitioner’s”
GENERAL DOCUMENTATION REQUIREMENTS:
Revised: Prescriptions (orders) to SWO

03/19/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).
R9 · 2020-01-01 · v28
Revision Effective Date: 01/01/2020
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed HCPCS
Revised: "physician" to "practitioner"
Revised: Order information as a result of Final Rule 1713
CODING INFORMATION:
Removed: Field titled “Bill Type”
Removed: Field titled “Revenue Codes”
Removed: Field titled “ICD-10 Codes that Support Medical Necessity”
Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity”
Removed: Field titled “Additional ICD-10 Information”
DOCUMENTATION REQUIREMENTS:
Revised: “physician’s” to “treating practitioner’s”
GENERAL DOCUMENTATION REQUIREMENTS:
Revised: Prescriptions (orders) to SWO

03/19/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).
R8 · 2020-01-01 · v22
Revision Effective Date:01/01/2020
HCPCS CODES:
Added: HCPCS E2398 to Group 9 codes, per annual HCPCS code release
R8 · 2020-01-01 · v22
Revision Effective Date:01/01/2020
HCPCS CODES:
Added: HCPCS E2398 to Group 9 codes, per annual HCPCS code release
R7 · 2019-01-01 · v20
Revision Effective Date: 01/01/2019
HCPCS CODES:
Revised: K0037 narrative to remove "replacement only"
R7 · 2019-01-01 · v20
Revision Effective Date: 01/01/2019
HCPCS CODES:
Revised: K0037 narrative to remove "replacement only"
R6 · 2018-01-01 · v16
Revision Effective Date: 01/01/2018


HCPCS CODES:


Added: E0954 to Group 2 codes


12/21/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
R6 · 2018-01-01 · v16
Revision Effective Date: 01/01/2018


HCPCS CODES:


Added: E0954 to Group 2 codes


12/21/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
R5 · 2017-01-01 · v14
Revision Effective Date: 01/01/2017
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: Standard Documentation Language
Added: New reference language and Directions to Standard Documentation Requirements
Added: General Requirements
HCPCS CODES:
Revised: Descriptor changed in Group 1 - K0015, K0019; Group 2 - E0995, K0037, K0042,  K0043, K0044, K0045, K0046, K0047, K0050, K0051, K0052; Group 4 -E0967, E2206, E2220, E2221, E2222, E2224, K0069, K0070, K0071, K0072, K0077; Group 8 - K0098
DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: General Documentation Requirements
Added: New reference language and Directions to Standard Documentation Requirements
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: Direction to Standard Documentation Requirements
Removed: Information under Miscellaneous
Removed: Information under Appendices
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements article
R5 · 2017-01-01 · v14
Revision Effective Date: 01/01/2017
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: Standard Documentation Language
Added: New reference language and Directions to Standard Documentation Requirements
Added: General Requirements
HCPCS CODES:
Revised: Descriptor changed in Group 1 - K0015, K0019; Group 2 - E0995, K0037, K0042,  K0043, K0044, K0045, K0046, K0047, K0050, K0051, K0052; Group 4 -E0967, E2206, E2220, E2221, E2222, E2224, K0069, K0070, K0071, K0072, K0077; Group 8 - K0098
DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: General Documentation Requirements
Added: New reference language and Directions to Standard Documentation Requirements
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: Direction to Standard Documentation Requirements
Removed: Information under Miscellaneous
Removed: Information under Appendices
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements article
R4 · 2016-07-01 · v9
Effective July 1, 2016 oversight for DME MAC LCDs is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the LCDs.
R4 · 2016-07-01 · v9
Effective July 1, 2016 oversight for DME MAC LCDs is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the LCDs.
R3 · 2016-01-01 · v8
Revision Effective Date: 01/01/2016
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: HCPCS code E1012 to Power Tilt and/or Recline Seating Systems range
HCPCS CODES:
Added: HCPCS code E1012
Revised: K0017 and K0018 long narrative description
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
R3 · 2016-01-01 · v8
Revision Effective Date: 01/01/2016
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: HCPCS code E1012 to Power Tilt and/or Recline Seating Systems range
HCPCS CODES:
Added: HCPCS code E1012
Revised: K0017 and K0018 long narrative description
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
R2 · 2015-10-01 · v5
Revision Effective Date: 10/31/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary’s Medicare eligibility
Added: HCPCS Codes E2358 and E2359 to the Batteries/Chargers section
DOCUMENTATION REQUIREMENTS:
Deleted: Reference to refill of supplies from Continued Use
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
Added: Repair/Replacement section
R2 · 2015-10-01 · v5
Revision Effective Date: 10/31/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary’s Medicare eligibility
Added: HCPCS Codes E2358 and E2359 to the Batteries/Chargers section
DOCUMENTATION REQUIREMENTS:
Deleted: Reference to refill of supplies from Continued Use
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
Added: Repair/Replacement section
R1 · 2015-10-01 · v4
07/01/2013 (June 2014 Publication)
MISCELLANEOUS:
Removed: Requirement for accessories to be billed on the same claim as base
R1 · 2015-10-01 · v4
07/01/2013 (June 2014 Publication)
MISCELLANEOUS:
Removed: Requirement for accessories to be billed on the same claim as base
Receipts for auditors

Version 8 of LCD L33792, shown on this page: in force by CMS's dates 2016-01-01 to 2015-12-31. Archived 2026-09-26. CMS's copy · Our archived file. 8 of 8 sections are proven word-identical to the archived file.

Every archived version of LCD L33792 (26 versions, CMS's dates, window by the as-of rule).

DocumentVersionIn forceArchived onVerify
LCD L33792version 22015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 22015-10-01, superseded same day2026-10-02CMS's copy · Our archived file
LCD L33792version 42015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 42015-10-01, superseded same day2026-10-02CMS's copy · Our archived file
LCD L33792version 52015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 52015-10-01 to 2015-12-312026-10-02CMS's copy · Our archived file
LCD L33792version 8 shown2016-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 82016-01-01 to 2016-06-302026-10-02CMS's copy · Our archived file
LCD L33792version 92016-07-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 92016-07-01 to 2016-12-312026-10-02CMS's copy · Our archived file
LCD L33792version 142017-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 142017-01-01 to 2017-12-312026-10-02CMS's copy · Our archived file
LCD L33792version 162018-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 162018-01-01 to 2018-12-312026-10-02CMS's copy · Our archived file
LCD L33792version 202019-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 202019-01-01 to 2019-12-312026-10-02CMS's copy · Our archived file
LCD L33792version 222020-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 222020-01-01, superseded same day2026-10-02CMS's copy · Our archived file
LCD L33792version 282020-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 282020-01-01 to 2023-05-152026-10-02CMS's copy · Our archived file
LCD L33792version 312023-05-16, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 312023-05-16 to 2024-03-312026-10-02CMS's copy · Our archived file
LCD L33792version 362024-04-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33792version 362024-04-01 to 2025-03-312026-10-02CMS's copy · Our archived file
LCD L33792version 412025-04-01 to 2025-09-302026-10-02CMS's copy · Our archived file
LCD L33792version 432025-10-01 to today2026-09-26CMS's copy · Our archived file

The related Articles each have their own receipts: Article A55426 · Article A52504.

Each archived file's page gives its sha256 fingerprint. A copy of the file hashes to the same value, byte for byte.

CMS's live page shows only the current version. To check a passage by eye, open CMS's copy of the same version number. A version's window ends on the earlier of CMS's stated end date and the day before the next version starts.

Every policy word on this page is CMS's, from the archived version named beside it. Verzi adds labels, highlights, citations and links only. Verzi-written summary content on this page: none.

Governing policies, as CMS lists them:

  • LCD L33792 · Wheelchair Options/Accessories
    CMS lists K0077 in group 4 of version 43. CMS's description, quoted: “FRONT CASTER ASSEMBLY, COMPLETE, WITH SOLID TIRE, REPLACEMENT ONLY, EACH”.
    Related Articles, as CMS lists them: Article A55426 · Article A52504
  • LCD L40345 (on CMS's site; not in the Verzi KB yet)
    CMS lists K0077 in group 4 of version 10. CMS's description, quoted: “FRONT CASTER ASSEMBLY, COMPLETE, WITH SOLID TIRE, REPLACEMENT ONLY, EACH”.

From CMS's LCD code table. HCPCS Level II codes only.

source

CMS's LCD code table in the Medicare Coverage Database download, archived 2026-10-09: Our archived file.

Watch K0077

One email when any policy cited for K0077 changes or gains a future effective date. Nothing else, ever.