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Walkers (DME) Coverage Criteria
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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.
Applicable HCPCS codes E0152 and E1399 were added to the Applicable Codes list.
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.
Providers must verify the member-specific benefit plan and any applicable federal or state mandates before ordering.
Coverage is conditioned on two requirements: (1) the patient meets the clinical medical necessity criteria as defined by InterQual Medicare: Post Acute & Durable Medical Equipment; Walkers, and (2) the member's specific benefit plan allows coverage for the requested walker or accessory. Providers must use the referenced InterQual criteria to support medical necessity determinations and also verify plan terms before ordering or billing.
The listing of a HCPCS code in this policy is for reference only and does not by itself indicate that the service is a covered benefit. Benefit coverage and payment are determined by the member-specific benefit plan document and applicable laws or mandates; other policies and guidelines may apply. Providers should confirm coverage and any authorization requirements with the member's plan prior to claim submission.
Medical Necessity
InterQual-based criteria
Medical necessity is determined by the referenced InterQual criteria; coverage is subject to the member-specific benefit plan.
Also subject to the member-specific benefit plan terms; when plan terms conflict, the member-specific benefit plan governs.
Applicable Codes
| 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. |
Provider Actions & Requirements
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.
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.
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.
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.
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
Rental and Purchase Rules
| 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
Documentation Requirements
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.
Not Covered
This policy does not list any items that are categorically not covered. However, inclusion of a HCPCS code does not guarantee coverage; benefit determinations depend on the member-specific benefit plan and applicable laws or mandates. Providers should verify plan terms and authorization requirements for each patient.
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