Walkers

Affected Providers

Practitioners, DME suppliers, and those who bill for walkers.

HCPCS & CPT Codes

Local Coverage Determination (LCD): Walkers (L33791) has the current HCPCS and CPT codes. 

Background

According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the improper payment rate for walkers is 14.3%, with a projected improper payment amount of $3.9 million.

Preventing Denials

We cover mobility assistive equipment (MAE), including a walker, as reasonable and necessary if the patient has a personal mobility deficit that impairs their mobility-related activities of daily living (MRADLs) (for example, toileting, feeding, dressing, grooming, and bathing in customary locations within the home). We base coverage and payment determinations on the clinical criteria for MAE coverage.

1. The patient has a mobility limitation that significantly impairs their ability to take part in 1 or more MRADLs in the home. The mobility limitation meets 1 one of these requirements:
   1. Prevents the patient from doing the MRADL entirely
   2. Places the patient at reasonably heightened risk of morbidity or mortality secondary to trying to do the MRADL
   3. Prevents the patient from completing the MRADL within a reasonable time frame
2. The patient can safely use the walker.
3. Using a walker can resolve the functional mobility deficit.

We cover a heavy duty walker (HCPCS codes E0148 and E0149) for patients who meet coverage criteria for a standard walker and weigh more than 300 pounds. If you provide an E0148 or E0149 walker and the patient weighs 300 pounds or less, we deny it as not reasonable and necessary.

We don’t cover a powered walker (HCPCS code E0152) because it doesn’t meet the definition of DME.

Documentation Requirements

To justify payment, you must meet specific requirements when ordering DMEPOS.