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Walkers

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A standard walker and related accessories are covered if all the following Criteria are met:

  • The patient 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 patient from accomplishing the MRADL entirely, or
  2. Places the patient at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform the MRADL, or
  3. Prevents the patient from completing the MRADL within a reasonable time frame; and
    1. The patient is able to safely use the walker; and
    2. The functional mobility deficit can be sufficiently resolved with the use of a walker

If all of the Criteria are not met, the walker will be denied as not medically necessary.

A heavy duty walker is covered for patients who meet coverage Criteria for a standard walker and who weigh more than 300 pounds. If a walker is provided and the patient does not weigh more than 300 pounds but does met coverage Criteria for a standard walker, payment will be based on the allowance for the least costly medically appropriate alternative, respectively.

The medical necessity for a walker with an enclosed frame compared to a standard folding wheeled walker, has not been established. Therefore, if the basic coverage Criteria for a walker are met, payment will be based on the allowance for the least costly medically appropriate alternative.

A walker trunk support is covered for patients who meet coverage Criteria for a standard walker and who have documentation in the medical record justifying the medical necessity for the special features. If a walker is provided and the special features are not justified, but the patient does meet the coverage Criteria for a standard walker, payment will be based on the allowance for the least costly medically appropriate alternative.

(MRADL) MOBILITY - RELATED - ACTIVITIES - DAILY LIVING

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