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LCD - Walker

Coverage Summary

Written order prior to delivery All (3) 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, AND;

  • The patient is able to safely use the walker, AND;

  • The functional mobility deficit can be sufficiently resolved with use of a walker.

Note: For patient discharging due to total knee or other knee surgical procedure:

    1. Progress note outlining the medical need for surgery (signed/dated by the Dr)
    2. Operative report (signed/dated by the Dr.)
    3. Equipment Order (signed/dated by the Dr.)
    4. PT Evaluation (signed/dated by PT)

Order Requirements

  • DME Order Form
  • Dr. must be PECOS registered for all Medicare orders.

  1. Patient Name
  2. Specific description of ordered items to be delivered (Rolling Walker, Rolling Walker with Basket, Walker with no Wheels)
  3. Length of Medical Need (ie, lifetime or other)
  4. Ordering Physician’s NPI
  5. Ordering physician’s legible signature (personally written or electronically signed by the physician, stamps are not accepted by insurance.)
  6. Ordering physician’s legible signature date (personally written or electronically signed by the physician, stamps are not accepted by insurance.)
  7. Start date of the order – if different than signature date.

Coverage Detail

Patient MUST meet all criteria 1-3

  1. The beneficiary has a mobility limitation that significantly impairs his/hers ability to participate in one or more mobility-related activities of daily living (MRADL) in the home.
  2. The beneficiary is able to safely use the walker; and
  3. The functional mobility deficit can be sufficiently resolved with use of a walker

A Mobility Limitation is one that:

  • Prevents the beneficiary from accomplishing the MRADL entirely, or
  • Place the beneficiary at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform the MRADL, or
  • Prevents the beneficiary from completing the MRADL within a reasonable time frame; and)

NOTE:

  • Heavy Duty Walker is covered if the patient weighs more than 300 lbs.
  • Equipment is covered one time every (5) years. If replacement is required within the (5) year covered time period, the patient may privately responsible for the equipment by signing an Advanced Beneficiary Notice form (ABN). This form identifies why a provider believes equipment would be non-covered and allows payment to be obtained at time of delivery.
  • The patient’s medical record must include the height and weight in order to select the proper equipment to meet the patient’s need.
  • Equipment prescribed and documented for use outside the home is non-covered.