Medicare · Power Wheelchairs · CMS FOIA PDFOIA-250808-01

2000–2005 · pre-crackdown (6 years)
claims per year
10,745
denial rate
30.0%
denied dollars/year
$21M
active suppliers
5,552
2022–2025 · post-crackdown (3.5 years)
claims per year
208,496 +19×
denial rate
13.5% −16.5 pts
denied dollars/year
$328M +15×
active suppliers
1,912 −66%
Compare by:

Grouped bar chart comparing nine HCPCS billing codes across two eras. Blue bars represent 2000–2005 pre-crackdown values; orange bars represent 2022–2025 post-crackdown values. In the annualised dollars denied view: K0011 (the dominant pre-crackdown code) had about $19.6M denied per year but now shows near zero, while K0861 (the dominant post-crackdown complex rehab chair) shows $130M denied per year with no pre-crackdown equivalent. K0823 now shows $70.7M denied per year from zero. The full comparison data is available in the table below.

Old codes — effectively erased by the crackdown
K0011 — 60,306 claims → 6 today
K0014 — 1,194 claims → 3 today
K0012 — 1,034 claims → 30 today
K0010 — 1,883 claims → 1 today
New codes — did not exist before the crackdown
K0823 — 0 → 439,617 claims total
K0821 — 0 → 76,349 claims total
K0825 — 0 → 73,781 claims total
K0861 — 0 → 56,118 claims total
What changed: The crackdown retired 4 broad codes and replaced them with 30+ granular K-codes — each requiring specific documentation, physician sign-off, and functional assessments. The fraud rate fell. But the documentation burden fell heaviest on legitimate patients, and the supplier market collapsed by two-thirds, leaving many areas with no compliant DME provider at all.
Full code-by-code comparison data table (keyboard & screen reader accessible)
Comparison of Medicare power wheelchair billing code activity between 2000–2005 (pre-crackdown) and 2022–2025 (post-crackdown). Source: CMS FOIA PDFOIA-250808-01.
Code P1 Claims/yr P1 Denial rate P1 $/yr denied P1 Suppliers P2 Claims/yr P2 Denial rate P2 $/yr denied P2 Suppliers Volume change
K0011
Standard motorized wheelchair (pre-crackdown dominant code)		 10,051 29.6% $3.3M 5,219 ~0 100% ~$0 2 Effectively gone
K0823
Group 2 standard, captain's chair, up to 300 lb		 ~0 — — — 123,836 12.1% $19.9M 1,624 New code
K0861
Group 3 standard, multiple power option (complex rehab)		 ~0 — — — 15,808 17.3% $130.2M 995 New code · 39.7% of all denied $
K0821
Group 2 standard, portable, up to 300 lb		 ~0——— 21,50711.6%$3.4M657 New code
K0825
Group 2 heavy duty, captain's chair		 ~0——— 20,78313.9%$3.9M1,028 New code
K0835
Group 2 standard, single power option, up to 300 lb		 ~0——— 2,01022.9%$3.9M648 New code
K0856
Group 3 standard, single power option		 ~0——— 2,40519.7%$6.3M666 New code
K0014
Other motorized/power wheelchair base		 19943.8%$163K457 ~0100%~$02 Effectively gone
K0012
Lightweight portable motorized wheelchair		 17235.1%$25K333 8100%~$04 −95%

Source: CMS FOIA PDFOIA-250808-01 · Period 1: Jan 1 2000 – Dec 31 2005 · Period 2: Jan 1 2022 – Jul 19 2025 · Extracted from IDR Aug 19 2025.