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HealthPartners

Coverage criteria policies

Walkers

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for walkers.

Coverage

Walkers are generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

A standard walker (E0130, E0135, E0141, E0143) and related accessories are covered if all of the following criteria (1-4) are met:

  1. A written signed and dated order is obtained by the vendor;
  2. The member has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADL) in the home. A mobility limitation is one that:
    1. Prevents the member from accomplishing the MRADL entirely, or
    2. Places the member at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform the MRADL, or
    3. Prevents the member from completing the MRADL within a reasonable time frame; and
  3. The member is able to safely use the walker; and
  4. The functional mobility deficit can be sufficiently resolved with use of a walker.

A heavy duty walker (E0148, E0149) is covered for members who meet coverage criteria for a standard walker and who weigh more than 300 pounds.

A heavy duty, multiple braking system, variable wheel resistance walker (E0147) is covered for members 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 an E0147 walker.

Code E0147 describes a 4-wheeled, adjustable height, folding-walker that has all of the following characteristics:

  1. Capable of supporting members who weigh greater than 350 pounds
  2. Hand operated brakes that cause the wheels to lock when the hand levers are released
  3. The hand brakes can be set so that either or both can lock both wheels
  4. The pressure required to operate each hand brake is individually adjustable
  5. There is an additional braking mechanism on the front crossbar
  6. At least two wheels have brakes that can be independently set through tension adjustability to give varying resistance

A walker with trunk support (E0140) is covered for members who meet coverage criteria for a standard walker and who have documentation in the medical record justifying the medical necessity for the special features.

Leg extensions (E0158) are covered only for members 6 feet tall or more.

Gait trainer is a term used to describe certain devices that are used to support a member during ambulation, similar to a walker.

The vendor should address & determine the following:

  1. Medical condition or diagnosis;
  2. Age;
  3. Current level of functioning;
  4. Less costly alternatives have been tried and the outcome;
  5. Trial gait trainer and outcome;
  6. Medical necessity for accessories needed (e.g., leg/arm straps, etc.);
  7. Location where the gait trainer will be used; and
  8. Name and model of gait trainer

Additional charges for convenience items or enhancement accessories which do not contribute significantly to the therapeutic function of the walker / gait trainer are not covered. (See “indications that are not covered” below.)

Crutch substitutes (E0118), including but not limited to items such as “Roll-A-Bout”, are covered when all of the following criteria are met:

  1. Member is not able to use crutches due to lack of physical strength or is at increased risk of falls.
  2. The crutch substitute is more efficient and negotiable in the member’s home environment than a walker or wheelchair; OR member does not have sufficient upper extremity function to propel a manual wheelchair in their home; OR member's home does not accommodate use of a manual wheelchair (doorways are too narrow to provide access between rooms, no maneuvering space, etc.).
  3. The crutch substitute enables the member to comply with the physician's order for non-weight bearing status while still maintaining normal daily activities in the home.

When criteria are met, a crutch substitute will be covered as a rental item capping at 4 months or when the purchase price is met. Once the purchase price is reached, this item will be owned by the member.

Indications that are not covered

  1. If all of the above criteria are not met, the walker will be denied as not medically necessary.
  2. Seated walkers (E0144): The medical necessity for a walker with an enclosed frame (E0144) which is described as a rigid or folding wheeled walker which has a frame that completely surrounds the member and has an attached seat in the back compared to a standard folding wheeled walker (E0143) has not been established. Therefore, if the basic coverage criteria for a walker are met and code E0144 is billed, payment will be based on the allowance for the least costly medically appropriate alternative, E0143.
  3. Seat attachments (E0156) for walkers are not considered medically necessary as they are used for comfort or convenience which is excluded in your member contract.
  4. Additional charges for convenience items or enhancement accessories which do not contribute significantly to the therapeutic function of the walker are not covered. They may include, but are not limited to style, color, hand operated brakes (other than those described in code E0147), or basket (or equivalent).
  5. If an E0148 or E0149 heavy duty walker is provided and the member does not weigh more than 300 pounds but does meet coverage criteria for a standard walker, payment will be based on the allowance for the least costly medically appropriate alternative, E0135 or E0143 respectively.
  6. If an E0147 heavy duty, multiple braking system walker is provided and the coverage criteria for a standard walker are met but the additional coverage criteria for an E0147 are not met, payment will be based on the allowance for the least costly medically appropriate alternative, E0143 or E0149 depending on the member’s weight.
  7. If an E0140 walker with trunk support is provided and the special features are not justified, but the member does meet the coverage criteria for a standard walker, payment will be based on the allowance for the least costly medically appropriate alternative.
  8. Crutch substitute (E0118), including but not limited to items such as a “Roll-A-Bout”, are not covered when used for comfort or convenience, vocation or recreation which is excluded in your member contract.

If available, codes for a procedure, device or diagnosis are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Non-covered HCPCS codes:

Codes

Description

E0144

Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat

E0156

Seat attachment, walker

E0157

Crutch attachment, walker, each

The following is a list of items eligible for coverage for purchase only:

Codes

Description

E0130

Walker, rigid pick-up, adjustable or fixed height

E0135

Walker - folding pick-up, adjustable or fixed height

E0140

Walker, with trunk support, adjustable or fixed height, any type

E0141

Rigid walker, wheeled, w/out seat

E0143

Folding walker, wheeled, w/out seat

E0147

Heavy duty, multiple breaking system, variable wheel resistance walker

E0148

Walker, heavy duty, without wheels, rigid or folding, any type, each

E0149

Walker, heavy duty, wheeled, rigid or folding, any type, each

E0153

Platform attachment, forearm crutch, each

E0154

Platform attachment, walker, each

E0155

Wheel attachment, rigid pick-up walker, per pair

E0158

Leg extensions for walker, per set of 4

E0159

Brake attachment for wheeled walker, replacement, each

E8000

Gait trainer, pediatric size, posterior support, includes all accessories and components

E8001

Gait trainer, pediatric size, upright support, includes all accessories and components

E8002

Gait trainer, pediatric size, anterior support, includes all accessories and components

The following is a list of items eligible for coverage for rental:

Codes

Description

E0118

Crutch substitute, lower leg platform

CPT Copyright American Medical Association. All rights reserved.  CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy contact Member Services at 952-883-7979 or 1-800-233-9645.

Vendor

For in-network benefits to apply, item must be received from a contracted vendor or provider.

References

  1. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2017). Walkers. Local Coverage Determination No. L33791. Retrieved from https://www.cms.gov/medicare-coverage-database on January 4, 2018.
  2. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2017). Walkers. Local Coverage Article No. A52503. Retrieved from https://www.cms.gov/medicare-coverage-database on January 4, 2018.

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Policy activity

  • 03/20/2007 - Date of origin
  • 01/01/2018 - Effective date
Review date
  • 01/2018
Revision date
  • 01/13/2017

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