CurrentUnitedHealthcarePolicy 202570642H

Walkers (DME) Coverage Criteria

This policy governs coverage and clinical criteria for walkers (durable medical equipment) for UnitedHealthcare Commercial and Individual Exchange benefit plans. It directs providers to InterQual Medicare: Post Acute & Durable Medical Equipment; Walkers for medical necessity criteria.

Policy Summary

PayerUnitedHealthcare

PolicyWalkers (DME) Coverage Criteria

Policy CodePolicy 202570642H

Change TypeCodes added

Effective DateJun 1, 2025

Next Review DateN/A

Key ActionVerify member-specific benefit plan and authorization requirements prior to ordering and claim submission.

SourceLink

POLICY UPDATE CHANGES

Applicable HCPCS codes E0152 and E1399 were added to the Applicable Codes list.

~16HCPCS codes listed (approximate)

2Covered plan types named

InterQualExternal clinical criteria source referenced

Coverage Criteria

Medical Necessity (InterQual referenced)

Covered when InterQual Medicare: Post Acute & Durable Medical Equipment; Walkers criteria are met and the member's benefit plan allows coverage.

Policy Summary

PayerUnitedHealthcare

PolicyWalkers (DME) Coverage Criteria

Policy CodePolicy 202570642H

Change TypeCodes added

Effective DateJun 1, 2025

Next Review DateN/A

Key ActionVerify member-specific benefit plan and authorization requirements prior to ordering and claim submission.

SourceLink

On This Page

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Medical Necessity

InterQual-based criteria

Medical necessity is determined by the referenced InterQual criteria; coverage is subject to the member-specific benefit plan.

InterQual-based necessity: Patient must meet the specific InterQual Medicare: Post Acute & Durable Medical Equipment; Walkers criteria referenced by this policy for walker selection and provision.

Also subject to the member-specific benefit plan terms; when plan terms conflict, the member-specific benefit plan governs.

Applicable Codes

Applicable HCPCS CodesHCPCS

A4636
A4637
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, 4 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 & Requirements

Prior Authorization

Verify coverage and authorization

Verify member eligibility and benefits, and obtain prior authorization when required by the member-specific benefit plan before delivering the walker. Coverage and reimbursement are contingent on the member's plan document and any applicable federal or state mandates.

Check member eligibility and benefit coverage prior to delivery.
Obtain prior authorization if required by the member-specific plan.
Document medical necessity per InterQual Medicare: Post Acute & Durable Medical Equipment; Walkers when applicable.

Documentation Required

Providers should refer to clinical coverage criteria (for example, InterQual Medicare: Post Acute & Durable Medical Equipment; Walkers) to support medical necessity determinations and include required documentation in the prior authorization request and the medical record.

Include diagnosis, functional limitations, and trial of less intensive alternatives when applicable.
Attach clinician notes, evaluation reports, and product specifications (E0-series HCPCS) to support the request.

Note

Member-specific benefit plan governs

Benefit coverage for walkers is determined by the member specific benefit plan document and applicable laws. In the event of a conflict between this Medical Policy and the member-specific benefit plan, the member-specific benefit plan governs.

Member-specific plan terms and state/federal mandates may require coverage beyond this policy.
Confirm any Medicare NCDs/LCDs or other Medicare guidance for Medicare Advantage members.

Billing Rule

Coverage contingent on member-specific plan

Coverage and payment are conditional upon the member’s specific benefit plan. Before furnishing equipment, verify that the plan includes DME/walker benefits and any applicable coverage criteria, limitations, or frequency rules.

Confirm that the applicable HCPCS code (for example, E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, A4636, A4637) is covered under the member’s plan.
Ensure documentation supports the specific code billed (product features such as wheeled, folding, trunk support, heavy‑duty).

Background

Walkers are assistive durable medical equipment used to improve mobility and provide support for patients who have difficulty walking independently. This policy governs coverage for standard rigid and folding walkers, wheeled walkers (rigid and folding), walkers with trunk support, heavy-duty and battery-powered walkers, and associated attachments and accessories. The policy delegates specific clinical necessity criteria to InterQual Medicare: Post Acute & Durable Medical Equipment; Walkers and requires providers to reference the member-specific benefit plan and any applicable federal or state mandates before ordering.

Definitions & Quick Codes

Applicable HCPCS codes (compact)

Primary HCPCS listA4636, A4637, E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148

Additional HCPCS (heavy-duty & power)E0149, E0152

Attachments and accessoriesE0154 (platform), E0155 (wheel attach, per pair), E0156 (seat attach), E0157 (crutch attach), E0158 (extensions, per set of four), E0159 (brake attachment, replacement, each)

Miscellaneous DME codeE1399 - Durable medical equipment; miscellaneous

Coverage requirement (actionable)Verify member-specific benefit plan and applicable mandates; listing a code does not guarantee coverage—confirm authorization prior to ordering.

Issue	Policy statement	Action for providers
Rental vs purchase
The policy does not specify whether walkers should be rented or purchased; coverage and the applicable rental/purchase rules are determined by the member-specific benefit plan.
Verify the member-specific benefit plan document for rental vs purchase provisions and any applicable federal or state mandates before ordering or billing.

Replacement, Repairs, and Attachments

Walkers and attachments

Covered walker typesStandard rigid walkers; folding walkers; wheeled walkers (rigid and folding); walkers with trunk support; heavy‑duty walkers (wheeled and non‑wheeled)

Powered walkerE0152 — Walker, battery powered, wheeled, folding, adjustable or fixed height.

Common attachmentsPlatform (E0154); wheel attachment (E0155); seat attachment (E0156); crutch attachment (E0157); leg extensions (E0158); brake attachment replacement (E0159).

MiscellaneousE1399 — Durable medical equipment; miscellaneous (used for items not otherwise classified).

Replacement interval guidance (actionable)Replacement interval for walkers and attachments: not specified in policy — follow member-specific benefit plan and InterQual guidance when applicable.

Documentation Requirements

Documentation Required

Reference member's benefit plan and InterQual criteria prior to ordering

Before ordering, verify the member specific benefit plan and apply InterQual Medicare: Post Acute & Durable Medical Equipment; Walkers criteria to document clinical necessity.

Confirm plan coverage, prior authorization requirements, and any state/federal mandates.
Document how the patient meets the InterQual criteria referenced by the policy.

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