K0877 prior authorization | Blue Cross Blue Shield Oklahoma

K0877, Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds, is on the Blue Cross Blue Shield Oklahoma commercial prior authorization list. Not a coverage or referral decision.

Code: K0877
Description: Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
Source: 2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 249 Original policy

Blue Cross Blue Shield Oklahoma prior authorization

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