ModifiedUnitedHealthcarePolicy CS357NM.B

Walkers (for New Mexico Only)

State-specific UnitedHealthcare medical policy governing coverage of walkers and related durable medical equipment in New Mexico. References InterQual Medicare: Post Acute & Durable Medical Equipment, Walkers for medical necessity criteria and lists applicable HCPCS codes for billing/reference.

Policy Summary

PayerUnitedHealthcare

PolicyWalkers (for New Mexico Only)

Policy CodePolicy CS357NM.B

Change TypeAdded HCPCS codes E0152 and E1399

Effective DateJul 1, 2025

Next Review Date

Key ActionProviders must document that the patient meets the InterQual® Medicare: Post Acute & Durable Medical Equipment, Walkers clinical criteria when requesting coverage for a walker in New Mexico.

POLICY UPDATE CHANGES

HCPCS codes E0152 and E1399 were added to the applicable codes list.

Previous policy version CS357NM.A was archived.

1State-specific policy (New Mexico only)

22HCPCS/A-codes listed

Coverage Summary

This policy, Walkers (for New Mexico Only) (Policy Number CS357NM.B), is a state-specific UnitedHealthcare medical policy that governs coverage of walkers and related durable medical equipment for members in New Mexico only. Coverage is covered_with_criteria and is determined by meeting the referenced InterQual® Medicare criteria. Effective date: July 1, 2025; Last review: July 1, 2025.

Medical Necessity / Coverage Criteria

Coverage is determined by meeting InterQual® Medicare: Post Acute & Durable Medical Equipment, Walkers criteria.

ALL of the following

InterQual criteria requirement: Patient and requested walker must meet the InterQual® Medicare: Post Acute & Durable Medical Equipment, Walkers clinical criteria referenced by UnitedHealthcare
Refer to InterQual® Medicare: Post Acute & Durable Medical Equipment, Walkers for specific clinical criteria
State-specific applicability: Policy applies only to members in New Mexico
This medical policy is specific to the state of New Mexico

ref": "b1_0

title": "Medical Necessity / Coverage Criteria"

Documentation Required

Reference InterQual criteria for medical necessity

Providers must document that the patient meets the InterQual® Medicare: Post Acute & Durable Medical Equipment, Walkers clinical criteria referenced by UnitedHealthcare when requesting coverage for a walker in New Mexico.

Referenced tool: InterQual® Medicare: Post Acute & Durable Medical Equipment, Walkers

Coding

Covered / Applicable HCPCS codes (reference list)HCPCSCovered

A4636	Replacement, handgrip, cane, crutch, or walker, each.
A4637	Replacement, tip, cane, crutch, walker, each.
E0130	Walker, rigid (pickup), adjustable or fixed height.
E0135	Walker, folding (pickup), adjustable or fixed height.
E0140	Walker, with trunk support, adjustable or fixed height, any type.
E0141	Walker, rigid, wheeled, adjustable or fixed height.
E0143	Walker, folding, wheeled, adjustable or fixed height.
E0144	Walker, enclosed, four-sided framed, rigid or folding, wheeled with posterior seat.
E0148	Walker, heavy-duty, without wheels, rigid or folding, any type, each.
E0149	Walker, heavy-duty, wheeled, rigid or folding, any type.

1–10 of 18

1/2

Billing Rule

Use provided HCPCS codes for claims

Claims for walkers and related attachments/replacements should use the applicable HCPCS codes listed in this policy.

A4636
A4637
E0130
E0135
E0140
E0141
E0143
E0144
E0148
E0149
E0152
E0154
E0155
E0156
E0157
E0158
E0159
E1399

Background & Definitions

This UnitedHealthcare medical policy applies only to New Mexico and relies on the InterQual® Medicare: Post Acute & Durable Medical Equipment, Walkers criteria to define medical necessity for walkers. The policy lists applicable HCPCS codes for reference, but the listed codes do not guarantee coverage; benefit coverage is governed by federal, state, or contractual requirements and applicable laws.

Definitions

termInterQual®

definitionThird-party clinical criteria tool referenced for defining medical necessity (InterQual® Medicare: Post Acute & Durable Medical Equipment, Walkers).

Provider Actions