CurrentUnitedHealthcarePolicy CSNCT0642.04

Walkers (for North Carolina Only)

This policy governs coverage and coding guidance for walkers and related walker attachments for UnitedHealthcare members in North Carolina; providers should follow state Medicaid clinical criteria (5A-1) and applicable benefit contracts.

Policy Summary

PayerUnitedHealthcare

PolicyWalkers (for North Carolina Only)

Policy CodePolicy CSNCT0642.04

Change TypeCodes updated / operational

Effective DateJul 1, 2025

Next Review Date

Key ActionVerify member benefits and follow NC Medicaid 5A-1 medical necessity criteria and prior authorization rules before ordering or billing.

SourceLink

POLICY UPDATE CHANGES

HCPCS code E1399 was added to the Applicable Codes list.

Archived previous policy version CSNCT0642.03.

~20HCPCS codes listed (approximate)

NCState-specific applicability

1Related payer policy referenced

Coverage Criteria

Medical necessity reference

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Applicable Codes

Applicable HCPCS/CPT Codes (reference)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, 4 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 18

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Provider Actions & Requirements

Prior Authorization

Prior authorization/benefit verification

Providers must verify prior authorization and benefit coverage for members based on federal, state, and contractual requirements before delivering services. In the event of any conflict between this policy and the member's specific plan or regulatory requirements, the federal, state, or contractual requirements govern.

Check member-specific plan benefits and state Medicaid fee schedules prior to ordering equipment or supplies.
Verify whether prior authorization is required by the member’s plan or state program.

Step Therapy

Step therapy

No step therapy requirements are specified in this policy.

If the member’s plan has its own step therapy program, follow the plan-specific step edits.
Providers should confirm any plan-specific step therapy requirements during benefit verification.

Documentation Required

Medical necessity and benefit documentation

Document medical necessity and benefit relevance per applicable North Carolina Medicaid clinical coverage criteria and the member's plan terms.

Follow North Carolina Medicaid Clinical Coverage Policies: Medical Equipment: 5A-1 (Physical Rehabilitation Equipment and Supplies) for medical necessity criteria.
Retain clinical documentation supporting medical necessity (e.g., evaluation, functional limitations, trial of lesser devices when applicable).
When plan terms differ from the NC Medicaid criteria, apply the federal/state/contractual requirements that govern the member’s coverage.

Billing Rule

State fee-schedule exclusions

Some HCPCS codes listed in this policy are not on the State of North Carolina Medicaid Fee Schedule and may not be covered by NC Medicaid; providers should check fee-schedule inclusion and reimbursement prior to billing.

Codes marked with an asterisk (*) in the Applicable Codes list are not on the State of North Carolina Medicaid Fee Schedule and therefore may not be covered by NC Medicaid.
Examples of codes potentially excluded from the NC Medicaid fee schedule: *E0140, *E0144, *E0147, *E0157, *E0159, *E0158? (verify specific status)
Verify fee-schedule status and reimbursement policy for each code with NC Medicaid or the member’s plan before ordering or billing.

Medical Necessity Determinations

NC Medicaid 5A-1 referenced criteria

Medical necessity determinations are made per NC Medicaid policy 5A-1.

Reference-based criteria: Coverage for walkers and attachments requires meeting the medical necessity criteria outlined in North Carolina Medicaid 5A-1 Physical Rehabilitation Equipment and Supplies.

This policy does not restate the clinical criteria; consult 5A-1.

Definitions / Examples

inv-09: Walker (HCPCS examples)

Rigid (pickup) walkerHCPCS E0130 — Walker, rigid (pickup), adjustable or fixed height.

Folding (pickup) walkerHCPCS E0135 — Walker, folding (pickup), adjustable or fixed height.

Walker with trunk supportHCPCS E0140 — Walker, with trunk support, adjustable or fixed height, any type. (marked with *)

Wheeled rigid/folding walkersHCPCS E0141 (rigid, wheeled) and E0143 (folding, wheeled) — adjustable or fixed height.

Enclosed 4-sided framed walker with seatHCPCS E0144 — Walker, enclosed, 4 sided framed, rigid or folding, wheeled with posterior seat. (marked with *)

Heavy-duty walker variantsHCPCS E0147 (heavy duty, multiple braking system) — marked with *; E0148 (heavy-duty without wheels); E0149 (heavy-duty, wheeled).

Replacement Parts and Attachments

inv-12: handgrip, tip, brake attachment

Replacement handgripHCPCS A4636 — Replacement, handgrip, cane, crutch, or walker, each.

Replacement tipHCPCS A4637 — Replacement, tip, cane, crutch, walker, each.

Brake attachment (replacement)HCPCS E0159 — Brake attachment for wheeled walker, replacement, each. (listed in replacement items summary)

Seat and platform attachmentsHCPCS E0156 — Seat attachment, walker; E0154 — Platform attachment, walker, each.

Wheel and crutch attachmentsHCPCS E0155 — Wheel attachment, rigid pick-up walker, per pair; E0157 — Crutch attachment, walker, each (marked with *).

Rule	Details / Provider action
Rental vs purchase determination
No specific rental versus purchase rules are stated in this policy; providers must follow the member's benefit plan and any applicable federal, state, or contractual requirements (for North Carolina, follow NC Medicaid policies and clinical coverage criteria 5A-1).

Documentation Requirements

Documentation Required

Follow NC Medicaid 5A-1 and verify member benefits before ordering

Follow the North Carolina Medicaid 5A-1 documentation requirements for medical necessity and verify the member's benefits and any federal/state/contractual rules before ordering equipment or submitting claims.

Ensure clinical documentation meets NC Medicaid 5A-1 criteria.
Confirm member benefit coverage and prior authorization requirements prior to procurement.

Background

This policy is an interpretation guide for UnitedHealthcare standard benefit plans specific to walkers and related attachments used for members in North Carolina. For medical necessity determinations and required documentation, providers must follow the North Carolina Medicaid Division of Health Benefits Clinical Coverage Policy 5A-1 (Physical Rehabilitation Equipment and Supplies). Prior authorization and coverage decisions also must conform to applicable federal, state, and contractual benefit requirements; providers should verify member benefits and NC Medicaid 5A-1 criteria before ordering or billing walkers and walker attachments.

Policy Summary

PayerUnitedHealthcare

PolicyWalkers (for North Carolina Only)

Policy CodePolicy CSNCT0642.04

Change TypeCodes updated / operational

Effective DateJul 1, 2025

Next Review Date

Key ActionVerify member benefits and follow NC Medicaid 5A-1 medical necessity criteria and prior authorization rules before ordering or billing.

SourceLink

On This Page

OpenPayer

Walkers (for North Carolina Only)

Coverage Criteria

Applicable Codes

Provider Actions & Requirements

Medical Necessity Determinations

Definitions / Examples

Replacement Parts and Attachments

Rental and Purchase Rules

Documentation Requirements

Not Covered / Exclusions

Background