CurrentUnitedHealthcarePolicy CS357.D

Walkers (Durable Medical Equipment)

Defines UnitedHealthcare's coverage and coding approach for walkers and walker accessories for standard benefit plans, delegating medical necessity determinations to InterQual Medicare DME criteria and noting state-specific policy exceptions.

Policy Summary

PayerUnitedHealthcare

PolicyWalkers (Durable Medical Equipment)

Policy CodePolicy CS357.D

Change TypeCodes addedClarified clinical criteria

Effective DateJul 1, 2025

Next Review DateN/A

Key ActionProvide clinical documentation consistent with InterQual Medicare: Post Acute & Durable Medical Equipment, Walkers to support authorization and payment.

SourceLink

POLICY UPDATE CHANGES

Added HCPCS codes E0152 and E1399 to the applicable codes list.

Policy references InterQual Medicare: Post Acute & Durable Medical Equipment, Walkers for medical necessity criteria.

Template Update.

Removed content/language pertaining to the state of Mississippi.

~20HCPCS codes listed for walkers and accessories

1External clinical criteria referenced (InterQual)

11States with separate walker policies called out

Coverage Criteria

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Coverage conditioned on InterQual criteria

Covered when InterQual criteria for medical necessity are met.

InterQual-based coverage: Medical necessity and coverage for walkers are determined by meeting the InterQual Medicare: Post Acute & Durable Medical Equipment, Walkers criteria.see InterQual

Providers must document clinical information consistent with InterQual to support coverage.

This Medical Policy does not apply in the states listed in the Application section; when a state-specific walker policy or guideline is identified, refer to that document for coverage determinations. Additionally, coverage and medical necessity for walkers are determined by meeting the InterQual Medicare: Post Acute & Durable Medical Equipment, Walkers criteria; providers must document clinical information consistent with InterQual to support authorization and payment.

Listing a HCPCS or other procedure/diagnosis code in this policy is for reference only and does not imply that the service is a covered benefit. Benefit coverage is governed by applicable federal, state, or contractual requirements and laws; inclusion of a code does not guarantee reimbursement or payment and other policies or guidelines may apply.

Coding and Codes

Applicable HCPCS Codes for Walkers and AccessoriesHCPCS

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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Clinical criteria source — InterQual Medicare: Post Acute & Durable Medical Equipment, Walkers

Clinical criteria sourceInterQual Medicare: Post Acute & Durable Medical Equipment, Walkers

How criteria are appliedMedical necessity and coverage for walkers are determined by meeting the InterQual Medicare: Post Acute & Durable Medical Equipment, Walkers criteria.

Provider documentationProviders must document clinical information consistent with InterQual to support authorization and payment.

Medical Necessity

InterQual-based DME medical necessity

Medical necessity is determined by InterQual criteria.

InterQual criteria: Patient meets the clinical indications and documentation requirements as specified in InterQual Medicare: Post Acute & Durable Medical Equipment, Walkers.see InterQual

Policy delegates detailed clinical criteria to InterQual; providers must supply InterQual-consistent documentation to support authorization and payment.

Provider Actions and Authorization

Prior Authorization

Authorization requires InterQual-consistent documentation

Coverage and medical necessity determinations for walkers are based on the InterQual® Medicare: Post Acute & Durable Medical Equipment, Walkers criteria; providers must submit clinical documentation that is consistent with those InterQual criteria to support authorization.

Prior authorization requests should reference InterQual determinations and include the clinical information InterQual requires.

Step Therapy

Step therapy — none specified; use InterQual criteria

No step therapy protocols are specified in this policy; medical necessity and any required sequencing of treatments are determined using the InterQual criteria referenced by this policy.

Note

Coverage decision guidance — follow benefit terms and InterQual

When making coverage decisions, reference the member’s federal, state, or contractual benefit terms first; UnitedHealthcare may use InterQual criteria to assist in administering benefits, but benefit terms govern in the event of a conflict.

Always check federal, state, or contractual requirements for benefit plan coverage before applying this policy.
InterQual may be used as a clinical tool to assist benefit administration, not as a substitute for plan terms.

Denial Risk

Coding listing is not authorization — codes are reference only

Listing of a HCPCS or other code in this policy is for reference only and does not imply the listed service is a covered or payable benefit; coverage and reimbursement are determined by federal, state, or contractual requirements and other applicable policies.

Inclusion of a code does not guarantee authorization, reimbursement, or claim payment.
Other policies and guidelines may apply that affect coverage determinations.

Documentation Requirements

Documentation Required

Document InterQual-consistent clinical evidence to support authorization and payment

Provide clinical documentation that demonstrates the InterQual criteria are met to support both authorization and payment; documentation must also comply with applicable federal, state, or contractual benefit requirements.

Include clinical findings and rationale that directly address the InterQual medical necessity elements.
Ensure submitted documentation aligns with the member’s benefit plan and any applicable laws.

Item	Rental vs Purchase Rules
Walkers and accessories
Policy does not specify rental versus purchase; follow the member's federal, state, or contractual benefit plan and medical necessity determinations per InterQual Medicare: Post Acute & Durable Medical Equipment, Walkers.

Replacement Parts and Accessories

Replacement parts and accessories

Replacement handgripA4636 — Replacement, handgrip, cane, crutch, or walker, each.

Replacement tipA4637 — Replacement, tip, cane, crutch, walker, each.

Brake attachment (replacement)E0159 — Brake attachment for wheeled walker, replacement, each.

Seat attachmentE0156 — Seat attachment, walker.

Platform attachmentE0154 — Platform attachment, walker, each.

Miscellaneous DMEE1399 — Durable medical equipment, miscellaneous.

Background

Walkers are recognized as medically necessary for certain patients to assist with ambulation and safety. This policy delegates specific clinical coverage decisions to InterQual Medicare: Post Acute & Durable Medical Equipment, Walkers; use InterQual criteria and the member’s benefit terms when determining medical necessity, and ensure clinical documentation aligns with those criteria to support authorization and payment.