CurrentUnitedHealthcarePolicy DME 051.5

Walkers (durable medical equipment)

This policy governs coverage and coding guidance for walkers as durable medical equipment under UnitedHealthcare Oxford standard benefit plans; it informs providers about applicable HCPCS codes and references InterQual criteria for medical necessity. It affects providers submitting claims for walker equipment and attachments for members covered by UnitedHealthcare Oxford.

Policy Summary

PayerUnitedHealthcare

PolicyWalkers (durable medical equipment)

Policy CodePolicy DME 051.5

Change TypeAdded HCPCS E0152 and E1399codes list updated

Effective DateJun 1, 2025

Next Review DateN/A

Key ActionVerify member benefit coverage and obtain prior authorization when required; use InterQual criteria to document medical necessity.

SourceLink

POLICY UPDATE CHANGES

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

Updated Applicable Codes section (codes list updated).

Removed References section from the policy.

Archived previous policy version DME 051.4.

~20HCPCS codes listed

InterQualMedical necessity criteria

DME 051.5Policy number

Coverage Criteria

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Medical necessity (general)

Covered when medical necessity is established per InterQual criteria and the member specific benefit plan allows coverage.

Medical necessity determination: Walker is proven and medically necessary in certain circumstances; medical necessity must meet InterQual criteria referenced by UnitedHealthcare.InterQual criteria

Providers should obtain documentation that meets InterQual rules and any plan-specific requirements; verify the member specific benefit plan document as plan terms may differ from the standard plan.

Applicable Codes

Applicable HCPCS CodesHCPCS

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

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Provider Actions & Billing Guidance

Prior Authorization

Prior Authorization & Medical Necessity

Prior authorization and medical necessity — Medical necessity determinations for walkers should follow the referenced InterQual criteria. Providers must obtain any required prior authorization per the member specific plan before ordering or delivering a walker.

Verify whether prior authorization is required with the member specific benefit plan before submitting an order or claim.
Use InterQual criteria (referenced in policy) to support medical necessity decisions.

Note

Operational Note for Providers

Provider operational note — This policy is intended to assist in interpreting UnitedHealthcare/Oxford standard benefit plans but does not replace the member specific benefit plan document. Providers should follow operational workflows and payer instructions when submitting orders and claims.

Follow UnitedHealthcare/Oxford operational processes for documentation and claims submission.
In the event of discrepancies between this policy and the member specific benefit plan, the member specific plan governs.

Documentation Required

Member Benefit Verification Required

Member benefit verification — Providers must check the member specific benefit plan document and any applicable federal or state mandates before using this policy or providing the walker.

Confirm member eligibility and specific benefit coverage, including any plan exclusions, limits, or prior authorization requirements.
Confirm whether Medicare Advantage, Medicaid, or other program rules apply, as Oxford policies may not apply to Medicare Advantage members.

Denial Risk

Coverage & Claim Payment Risk

Coverage and claim payment risk — Inclusion of a code in this policy does not imply coverage or guarantee payment; benefit coverage is determined by the member specific plan and applicable mandates.

Codes listed in the policy (e.g., A4636, A4637, E0130, E0135, E0140–E0158) are for reference only and do not guarantee payment.
Check member specific plan and medical necessity documentation when billing to reduce denial risk.

InterQual-based Medical Necessity

InterQual-based DME medical necessity

Medical necessity for provision or replacement of walkers and attachments must meet InterQual criteria and member plan requirements.

InterQual-based necessity: InterQual criteria must be met for walker provision, replacement, or attachments.InterQual determination

Refer to InterQual for specific clinical scenarios (e.g., functional impairment, inability to use cane/crutches, safety concerns). Verify member-specific benefit plan and any applicable federal or state mandates; the member specific benefit plan governs in the event of a conflict.

Definitions / Code Descriptions

inv-10: E0152 — HCPCS code definition for battery powered walker

HCPCS codeE0152

Short descriptionWalker, battery powered, wheeled, folding, adjustable or fixed height.

ContextListed in Applicable Codes for walkers; medical necessity must meet InterQual criteria and member benefit plan requirements.

inv-11: E1399 — HCPCS code definition for miscellaneous DME

HCPCS codeE1399

Short descriptionDurable medical equipment; miscellaneous.

ContextIncluded in Instructions for Use and Applicable Codes as a miscellaneous DME code for items not elsewhere classified; coverage subject to member plan and InterQual medical necessity determinations.

Rule	Policy guidance
Rental vs purchase determination
Policy text does not specify rental versus purchase rules. Follow the member-specific benefit plan document and applicable DME coverage guidelines; in the event of conflict, the member-specific benefit plan governs. Verify prior authorization and coverage requirements per the member plan before ordering.

Replacement Components & Attachments

inv-14: replacement components and attachments — details on replacements (inventory provided)

Included replacement partsA4636 (handgrip replacement), A4637 (tip replacement), E0159 (brake attachment replacement), and other attachments (E0154–E0158).

Policy guidanceReplacement components and attachments are listed but the policy does not specify replacement intervals; follow member-specific benefit plan and InterQual criteria for medical necessity.

Billing noteListing of replacement codes does not guarantee coverage or reimbursement; verify member benefit plan and obtain prior authorization if required.

Examples of attachmentsPlatform (E0154), wheel attachment (E0155), seat (E0156), crutch attachment (E0157), extensions (E0158), brake replacement (E0159).

Documentation Requirements