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    v1.0.31
    OpenPayerPolicy UpdatesDurable Medical Equipment (DME)North Dakota Gait Trainers Coverage | OpenPayer
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    CurrentNorth Dakota Department of Health & Human ServicesPolicy N/A

    Gait Trainers/Walkers

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    This policy governs Medicaid coverage and service authorization for gait trainers and walkers used by members with impaired ambulation. It establishes medical necessity criteria, documentation requirements, equipment-specific billing guidance, and non-covered accessories.

    Policy Summary
    PayerNorth Dakota Department of Health & Human Services
    PolicyGait Trainers/Walkers
    Policy CodePolicy N/A
    Change TypeRevised
    Effective DateMarch 1, 2007
    Next Review DateN/A
    Key ActionObtain service authorization before coverage of gait trainers and walkers.
    SourceLink
    POLICY UPDATE CHANGES

    The policy removed the stated replacement limits of one walker every seven years and one gait trainer every ten years from this document.

    The policy removed the Certificate of Medical Necessity (CMN) terminology from the header section.

    The practitioner examination documentation timeframe is 90 days before the service authorization start date.

    YesService authorization required

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    3
    Required medical necessity conditions
    90 daysMaximum practitioner exam interval
    >300 lbHeavy-duty equipment weight threshold
    3Pediatric gait trainer codes

    Initial Coverage Criteria

    Initial coverage criteria

    Coverage is allowed when ALL of the following conditions are present:

    All coverage conditions

    • Medical condition impairing ambulation: The member has a medical condition impairing ambulation.
    • Potential for ambulation: There is potential for ambulation.
    • Need for greater stability and security: The member needs greater stability and security.

    Enhancement accessories and other unique features of gait trainers or walkers are not separately payable. These items may not be billed separately using HCPCS E1399.

    Gait Trainer and Walker Medical Necessity

    Gait trainer and walker medical necessity

    Coverage is allowed if ALL of the following conditions are present:

    • Medical condition impairing ambulation: A medical condition impairs ambulation.
    • Potential for ambulation: There is potential for ambulation.
    • Greater stability and security needed: Greater stability and security are needed.

    Required Clinical Documentation

    Documentation Required

    Required Clinical Documentation

    Providers must submit the required clinical documentation to support authorization for gait trainers or walkers.

    • A prescription from a prescribing practitioner.
    • Documentation of a practitioner examination completed within 90 days before the service authorization start date.
    • Medical documentation supporting the need for the gait trainer or walker.

    Billing and Equipment Coding

    Pediatric gait trainer codesHCPCSCovered
    E8000Pediatric gait trainer
    E8001Pediatric gait trainer
    E8002Pediatric gait trainer
    Non-covered billing for enhancements and unique featuresHCPCSNot Covered
    E1399Unlisted durable medical equipment code; may not be used to separately bill enhancement accessories or other unique gait trainer/walker features
    Heavy-Duty Equipment
    Member weight thresholdMore than 300 lbs

    Authorization and Denial Risks

    Prior Authorization

    Obtain service authorization before coverage

    Service authorization is required before coverage of gait trainers and walkers. Obtain authorization before providing the equipment.

    Documentation Required

    Provide required clinical documentation

    Submit all required clinical documentation with the request.

    • A prescription from a prescribing practitioner.
    • A practitioner examination performed within 90 days of the service authorization start date.
    • Medical documentation supporting the need for the equipment.

    Policy Background

    Gait trainers and walkers are mobility-assistance devices for members whose medical conditions impair ambulation. Coverage is directed to members who retain potential for ambulation and require greater stability and security while walking, subject to the policy’s medical necessity, documentation, and service authorization requirements.

    Non-Covered Items

    Enhancement accessories and other unique gait trainer or walker features are not covered as separately payable items. Providers may not bill these enhancements or unique features with E1399.

    Policy Summary
    PayerNorth Dakota Department of Health & Human Services
    PolicyGait Trainers/Walkers
    Policy CodePolicy N/A
    Change TypeRevised
    Effective DateMarch 1, 2007
    Next Review DateN/A
    Key ActionObtain service authorization before coverage of gait trainers and walkers.
    SourceLink
    On This Page
    Initial Coverage CriteriaGait Trainer and Walker Medical NecessityRequired Clinical DocumentationBilling and Equipment CodingAuthorization and Denial RisksPolicy BackgroundNon-Covered Items
    Denial Risk

    Document medical necessity for the equipment

    Coverage may be denied when the member does not meet the medical necessity criteria for the equipment.

    • The member does not have a medical condition impairing ambulation.
    • There is no potential for ambulation.
    • The member does not need greater stability and security.
    Denial Risk

    Do not omit required documentation

    Coverage may be denied when required documentation is not provided. This includes the prescription, the practitioner examination within 90 days of the service authorization start date, or supporting medical documentation.

    Billing Rule

    Do not separately bill enhancements or unique features

    Enhancement accessories or other unique features of gait trainers or walkers are not separately payable and may not be billed with code E1399.