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Walkers
MA05.037a

Policy

 This policy uses coverage criteria developed solely based on applicable Medicare statutes, regulations, NCDs, LCDs, CMS manuals and other applicable Medicare coverage documents.

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​MEDICALLY NECESSARY
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STANDARD WALKER

A standard walker and related accessories are considered medically necessary and, therefore, covered when ALL of the following criteria are met:
  • The individual has a mobility limitation that significantly impairs their ability to participate in one or more mobility-related activities of daily living (MRADL) in the home, as defined by one of the following indications:
    • Prevents the individual from accomplishing the MRADL entirely
    • Places the individual at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform the MRADL
    • Prevents the individual from completing the MRADL within a reasonable time frame
  • The individual is able to safely use the walker.
  • The functional mobility deficit can be sufficiently resolved with use of a walker.
If above criteria are not met, the walker will be considered not medically necessary and, therefore, not covered.

HEAVY-DUTY WALKER

A heavy-duty walker is considered medically necessary and, therefore, covered for individuals who meet the coverage criteria for a standard walker and who weigh more than 300 pounds.

If a heavy-duty walker is provided and the individual weighs 300 pounds or less, it will be considered not medically necessary, and, therefore, not covered.

HEAVY-DUTY, MULTIPLE BREAKING SYSTEM WALKER

A heavy-duty, multiple-braking-system, variable-wheel-resistance walker is considered medically necessary, and, therefore, covered for individuals who meet coverage criteria for a standard walker and who are unable to use a standard walker due to a severe neurologic disorder or other condition causing the restricted use of one hand.

Obesity, by itself, is not a sufficient reason for a variable-wheel-resistance walker. If a variable-wheel-resistance walker is provided and the additional coverage criteria are not met, it will be considered not medically necessary and, therefore, not covered.

WALKER WITH TRUNK SUPPORT

A walker with trunk support is considered medically necessary and, therefore, covered for individuals who meet the coverage criteria for a standard walker and who have documentation in the medical record justifying the medical necessity for the special features.

If a trunk support walker is provided without meeting the above criteria, it will be considered not medically necessary, and, therefore, not covered.

LEG EXTENSIONS

Leg extensions are considered medically necessary and, therefore, covered only for individuals who are 6 feet or more in height.

NOT MEDICALLY NECESSARY 

A walker with an enclosed frame is considered not medically necessary, and therefore, not covered.


NOT COVERED 


A powered walker is not covered​ by the Company because it is an item not covered by Medicare. It does not meet Medicare's definition of durable medical equipment (DME). Therefore, the item is not eligible for reimbursement consideration.


Enhancement accessories of walkers that include but not limited to style, color, hand-operated brakes (other than those described in code E0147), baskets or equivalent are not covered by the Company because they are not items covered by Medicare. They do not meet Medicare's definition of DME because they do not contribute significantly to the therapeutic function of the walker. Therefore these items are not eligible for reimbursement consideration.


REQUIRED DOCUMENTATION

The Company may conduct reviews and audits of services to our members regardless of the participation status of the provider. Medical record documentation must be maintained on file to reflect the medical necessity of the care and services provided. These medical records may include but are not limited to: records from the professional provider’s office, hospital, nursing home, home health agencies, therapies, and test reports. This policy is consistent with Medicare's documentation requirements, including the following required documentation:

STANDARD WRITTEN ORDER REQUIREMENTS
Before submitting a claim to the Company, the supplier must have on file a timely, appropriate, and complete order for each item billed that is signed and dated by the professional provider who is treating the member. Requesting a provider to sign a retrospective order at the time of an audit or after an audit for submission as an original order, reorder, or updated order will not satisfy the requirement to maintain a timely professional provider order on file.

PROOF OF DELIVERY REQUIREMENTS
Medical record documentation must include a contemporaneously prepared delivery confirmation or member’s receipt of supplies and equipment. The medical record documentation must include a copy of delivery confirmation if delivered by a commercial carrier and a signed copy of delivery confirmation by member/caregiver if delivered by the DME supplier/provider. All documentation is to be prepared contemporaneous with delivery and be available to the Company upon request.

For specified DME items, documentation of a face-to-face encounter between the treating professional provider and the individual meeting the above requirements, including an assessment of the individual’s clinical condition supporting the need for the prescribed DME item(s), must be provided to and kept on file by the DME supplier.
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If required documentation is not available on file to support a claim at the time of an audit or record request, the DME supplier may be required to reimburse the Company for overpayments.

COLUMN I/COLUMN II REIMBURSEMENT EDITS

Column II code is included in the allowance for the corresponding Column I code when provided at the same time and must not be billed separately at the time of billing the Column I code.

Column I
Column II
E0130
A4636, A4637
E0135
A4636, A4637
E0140
A4636, A4637,E0155, E0159
E0141
A4636, A4637,E0155, E0159
E0143
A4636, A4637, E0155, E0159
E0144
A4636, A4637, E0155, E0156, E0159
E0147
A4636, E0155, E0159
E0148
A4636, A4637
E0149
A4636, A4637, E0155, E0159

Guidelines

This policy is consistent with Medicare's coverage criteria. The Company's payment methodology may differ from Medicare.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, walkers are covered under the medical benefits of the Company’s Medicare Advantage products when the medical necessity criteria listed in this medical policy are met. However, services that are identified in this policy as not medically necessary are not eligible for coverage or reimbursement by the Company.

Description

A walker or gait trainer is used to support an individual during ambulation. A gait trainer is a term used to describe certain devices that are used to support a patient during ambulation. Gait trainers serve the same purpose as walkers.
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A wheeled walker is one with two, three, or four wheels. It may be fixed height or have an adjustable height. It may or may not include glide-type brakes (or equivalent). The wheels may be fixed or swivel.

A glide-type brake consists of a spring mechanism (or equivalent), which raises the leg post of the walker off the ground when the individual is not pushing down on the frame.

A folding wheeled walker has a frame that completely surrounds the individual and an attached seat in the back.

A heavy-duty walker is one that is labeled as capable of supporting individuals who weigh more than 300 pounds. It may be fixed height or adjustable height. It may be rigid or folding.

A four-wheeled, adjustable height, folding walker is described as having all of the following characteristics:
  • Capable of supporting beneficiaries who weigh greater than 350 pounds
  • Hand-operated brakes that cause the wheels to lock when the hand levers are released
  • Hand brakes that can be set so that either or both can lock both wheels
  • Pressure required to operate each hand brake is individually adjustable
  • Additional braking mechanism on the front crossbar
  • At least two wheels with brakes that can be independently set through tension adjustability to give varying resistance

References

Noridian Healthcare Solutions. Local Coverage Determination (L33791). Walkers. [Noridian Healthcare Solutions Web site] Original: 10/01/15. (Revised 01/01/2020). Available at:
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33791. Accessed January 8, 2025.


Noridian Heathcare Solutions. Local Coverage Article(A52503). Walkers. [Noridian Healthcare Solutions Web site]. Original: 10/01/15. (Revised 04/01/2024). Available https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52503. Accessed January 8, 2025.​

Coding

CPT Procedure Code Number(s)
N/A
ICD - 10 Procedure Code Number(s)
N/A
ICD - 10 Diagnosis Code Number(s)
N/A
HCPCS Level II Code Number(s)
MEDICALLY NECESSARY 
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
E0147 Walker, heavy-duty, multiple braking system, variable wheel resistance​
E0148 Walker, heavy-duty, without wheels, rigid or folding, any type, each
E0149 Walker, heavy-duty, wheeled, rigid or folding, any type​
E0154 Platform attachment, walker, each
E0155 Wheel attachment, rigid pick-up walker, per pair
E0156 Seat attachment, walker
E0157 Crutch attachment, walker, each
E0158 Leg extensions for walker, per set of four
E0159 Brake attachment for wheeled walker, replacement, each

NOT MEDICALLY NECESSARY 
​E0144 Walker, enclosed, four-sided framed, rigid or folding, wheeled with posterior seat

NOT COVERED  
​E0152 Walker, battery powered, wheeled, folding, adjustable or fixed height

THE FOLLOWING CODE PRESENTS ENHANCEMENT ACCESSORIES (SUCH AS A WALKER BASKET):
E1399 Durable medical equipment, miscellaneous​​​
Revenue Code Number(s)
N/A


Coding and Billing Requirements

Policy History

Revisions From MA05.037a:
05/12/2025

​The version of this policy will become effective 05/12/2025.

In accordance with Medicare:

  • Not covered criteria has been added to the policy for a powered walker and enhancement accessories of the walker.
  • HCPCS codes E0152 and E1399 have been added to the policy as not covered.​
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Revisions From MA05.037:​
​02/07/2024
​This policy has been reissued in accordance with the Company's annual review process.
​01/01/2024

​​Effective 01/22/2024 this policy applies to New Jersey Medicare Advantage (MA) lines of business.
​01/01/2024
​This policy has been reissued in accordance with the Company's annual review process.​
​02/22/2023
​This policy has been reviewed and reissued to communicate the Company's continuing position for Walkers.​
​03/09/2022
​This policy has been reissued in accordance with the Company's annual review process.
03/10/2021​This policy has been reviewed and reissued to communicate the Company's continuing position for Walkers.​
​02/12/2020
​This policy has been reissued in accordance with the Company's annual review process.
​02/13/2019

​This policy has been reviewed and reissued to communicate the Company's continuing position for walkers.
​04/25/2018

​This policy has been reviewed and reissued to communicate the Company's continuing position for walkers.
​02/01/2017

​This policy has been reviewed and reissued to communicate the Company's continuing position for walkers.
​07/06/2016
​This policy has been reviewed and reissued to communicate the Company's continuing position for walkers.
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06/24/2015
​This policy has been reviewed and reissued to communicate the Company's continuing position for walkers.​
​01/01/2015
​This is a new policy.

5/12/2025
5/12/2025
MA05.037
Medical Policy Bulletin
Medicare Advantage
No