CurrentUnitedHealthcarePolicy CS357.D

Walkers (Durable Medical Equipment)

UnitedHealthcare medical policy CS357.D defines coverage guidance for walkers (durable medical equipment) for commercial lines, references InterQual Medicare Post Acute & Durable Medical Equipment criteria for medical necessity, lists applicable HCPCS codes, and includes state-specific applicability exclusions.

Policy Summary

PayerUnitedHealthcare

PolicyWalkers (Durable Medical Equipment)

Policy CodePolicy CS357.D

Change TypeTemplate update; HCPCS additions

Effective DateJul 1, 2025

Next Review Date

Key ActionProviders must document that members meet the InterQual Medicare Post Acute & Durable Medical Equipment walker criteria when requesting coverage.

POLICY UPDATE CHANGES

Template Update removed content/language pertaining to the state of Mississippi.

Added HCPCS codes E0152 and E1399 to the Applicable Codes list.

Archived previous policy version CS367.C.

1External Clinical Criteria Source Referenced (InterQual)

20HCPCS Codes Listed

11States with Alternate Policies Listed

Coverage Summary

UnitedHealthcare medical policy CS357.D (effective July 1, 2025) defines coverage guidance for walkers as durable medical equipment for commercial lines and lists applicable HCPCS codes for walkers and accessories.

The policy states the coverage stance as covered with criteria and delegates medical necessity determinations to the InterQual Medicare: Post Acute & Durable Medical Equipment; Walkers criteria. The policy also specifies states where this Medical Policy does not apply and notes state-specific policy/guideline references.

Medical-Necessity Criteria

Medical Necessity Criteria (per InterQual Medicare: Post Acute & Durable Medical Equipment; Walkers)

Covered when ALL of the following InterQual Medicare criteria for walkers are met:

InterQual delegation: Member meets the InterQual Medicare Post Acute & Durable Medical Equipment criteria for walker medical necessity

Policy delegates clinical coverage criteria to InterQual; exact items (e.g., functional limitations, mobility deficits) are defined in the InterQual criteria referenced by policy.

Documentation Required

Use InterQual criteria to document medical necessity

Providers must document that members meet the InterQual Medicare Post Acute & Durable Medical Equipment walker criteria when requesting coverage; the policy references InterQual as the source for the clinical coverage criteria.

Providers must document InterQual Medicare Post Acute & Durable Medical Equipment; Walkers criteria when requesting coverage.
Policy references InterQual as the clinical source for walker medical necessity.

Applicable HCPCS Codes

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.
E0147	Walker; heavy duty, multiple braking system, variable wheel resistance.
E0148	Walker; heavy-duty, without wheels, rigid or folding, any type, each.

1–10 of 19

1/2

Billing Rule

HCPCS codes provided for reference

When billing for walkers and accessories, use the provided HCPCS codes (A4636, A4637, E0130-E0159, E1399) as applicable; inclusion of a code does not guarantee payment and other policies/contractual/state requirements apply.

A4636
A4637
E0130-E0159
E1399
Listing of a code in this policy does not imply that the service described by the code is a covered or non-covered health service; inclusion does not guarantee payment and other policies/contractual/state requirements apply.

Background

This policy covers walkers as durable medical equipment for commercial plans and directs clinical coverage decisions to InterQual Medicare Post Acute & Durable Medical Equipment criteria for walkers.

The document provides a reference list of HCPCS codes for walkers and accessories (including codes such as A4636, A4637, E0130–E0159, E1399) and identifies specific states (for example, Idaho, Indiana, Kansas, Kentucky, Louisiana, Nebraska, New Jersey, New Mexico, North Carolina, Ohio, Pennsylvania, Tennessee) where this Medical Policy does not apply or where state-specific walker policies/guidelines should be used.

InterQual is described as a third-party clinical criteria tool used by UnitedHealthcare to determine medical necessity for Post Acute & Durable Medical Equipment, specifically the InterQual Medicare: Post Acute & Durable Medical Equipment; Walkers criteria.

Provider Actions / Billing Impact

Documentation Required

Use InterQual criteria to document medical necessity

Must document InterQual Medicare Post Acute & Durable Medical Equipment; Walkers criteria when requesting coverage.
Reference the InterQual product name: InterQual Medicare Post Acute & Durable Medical Equipment; Walkers.

Billing Rule

HCPCS codes provided for reference

When billing for walkers and accessories, use the provided HCPCS codes as applicable; inclusion of a code does not guarantee payment and other policies/contractual/state requirements apply.

A4636
A4637
E0130
E0135
E0140
E0141
E0143
E0144
E0147
E0148
E0149
E0152
E0154
E0155
E0156
E0157
E0158
E0159
E1399
Inclusion of a code in this policy does not imply any right to reimbursement or guarantee claim payment; other policies, contractual obligations, and state requirements may apply.

Revision History

07/01/2025revisedLatest