ModifiedUnitedHealthcarePolicy CS357NE.D

Walkers (for Nebraska Only)

State-specific UnitedHealthcare medical policy governing coverage and coding reference for walkers and walker accessories for members in Nebraska; points readers to Nebraska DHHS Code 471-7-004.02(NNN) for medical necessity criteria. Lists applicable HCPCS/DME codes and notes additions.

Policy Summary

PayerUnitedHealthcare

PolicyWalkers (for Nebraska Only)

Policy CodePolicy CS357NE.D

Change TypeRevised; Added codes; Reference update

Effective DateJuly 1, 2025

Next Review Date

Key ActionProviders must apply the medical necessity criteria in Nebraska DHHS Code 471-7-004.02(NNN) when requesting coverage for walkers and walker accessories for Nebraska members; UnitedHealthcare defers to that code for coverage determinations.

POLICY UPDATE CHANGES

Replaced referral instruction to Nebraska DHHS Code 471-7-000 with Code 471-7-004.02(NNN): Walkers.

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

Updated References section to reflect current Nebraska DHHS citation and archived prior policy version CS357NE.C.

22HCPCS / DME codes listed

1Governing state code referenced

Coverage Summary

State-specific UnitedHealthcare medical policy CS357NE.D governs coverage and coding reference for walkers and walker accessories for members in Nebraska and defers to the Nebraska Department of Health and Human Services Code 471-7-004.02(NNN) for medical necessity determinations. Effective date: July 1, 2025.

Medical Necessity / Coverage Criteria

Coverage / Medical Necessity

Refer to the Nebraska Department of Health and Human Services Code for specific medical necessity criteria:

Medical necessity clinical coverage criteria for walkers are governed by Nebraska DHHS Code 471-7-004.02(NNN): Walkers; UnitedHealthcare defers to that code for determinations.

Applicable HCPCS / DME Codes (reference)

Applicable HCPCS / DME Codes (reference list)HCPCS

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.

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Provider Actions & Billing

Documentation Required

Follow Nebraska DHHS criteria for medical necessity

Providers must apply the medical necessity criteria in Nebraska DHHS Code 471-7-004.02(NNN) when requesting coverage for walkers and walker accessories for Nebraska members; UnitedHealthcare defers to that code for coverage determinations.

Billing Rule

Use listed HCPCS codes for walker equipment and accessories

Report claims using the applicable HCPCS/DME codes listed in the policy (A4636, A4637, E0130–E0159, E1399); inclusion in the list is for reference and does not guarantee coverage or payment.

A4636
A4637
E0130
E0135
E0140
E0141
E0143
E0144
E0147
E0148
E0149
E0152
E0154
E0155
E0156
E0157
E0158
E0159
E1399

Background

This Nebraska-specific UnitedHealthcare policy defers to Nebraska DHHS Code 471-7-004.02(NNN): Walkers for medical necessity clinical coverage criteria for walkers and related accessories. The policy lists applicable HCPCS/DME reference codes (A4636, A4637, E0130–E0159, E1399) but notes that listing is for reference only and does not guarantee coverage or payment. Recent material changes replaced a prior referral to the broader DMEPOS code with the specific walkers code and appended HCPCS codes E0152 and E1399 to the Applicable Codes list; the References section and archival note were also updated.

Nebraska DHHS Code 471-7-004.02(NNN) is the state regulatory code specifying medical necessity criteria for walkers (Durable Medical Equipment) in Nebraska and is the standard UnitedHealthcare uses for coverage determinations for Nebraska members.

Revision History

07/01/2025revisedLatest

Replaced referral instruction to Nebraska DHHS Code 471-7-000 with Code 471-7-004.02(NNN): Walkers. (MATERIAL change)

07/01/2025added

Added HCPCS codes E0152 and E1399 to the Applicable Codes list. (MATERIAL change)

07/01/2025revised

Updated References section to reflect current Nebraska DHHS citation and archived prior policy version CS357NE.C. (Non-material change)