E0158 — Leg extensions for walker, per set of four (4)
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- A completed Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for items covered by this policy.
- For DMEPOS base items requiring a Written Order Prior to Delivery (WOPD), the supplier must have received a signed WOPD prior to delivering the item to the beneficiary.
- If separately billed associated options, accessories, and/or supplies require a WOPD of the base item, the WOPD must list the base item (and may list associated items) prior to delivery.
- Suppliers are required to maintain proof of delivery (POD) documentation in their files and must make POD available to the Medicare contractor upon request.
Key Coverage Criteria
- A standard walker (E0130, E0135, E0141, E0143) is covered when the beneficiary has a mobility limitation that significantly impairs one or more mobility-related activities of daily living (MRADL) in the home, the beneficiary can safely use the walker, and the functional mobility deficit can be sufficiently resolved with use of a walker.
- A heavy duty walker (E0148, E0149) is covered when the beneficiary meets the standard walker coverage criteria and weighs more than 300 pounds.
- A heavy duty multiple braking system, variable wheel resistance walker (E0147) is covered when the beneficiary meets standard walker criteria and is unable to use a standard walker due to a severe neurologic disorder or another condition causing restricted use of one hand.
- A walker with trunk support (E0140) is covered when the beneficiary meets standard walker criteria and the medical record documents the medical necessity for the trunk-support feature.
- Leg extensions (E0158) are covered only for beneficiaries who are 6 feet tall or taller.
- Canes, quad canes, and crutches are medically necessary if all of the following criteria are met: 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 (toileting, feeding, dressing, grooming, and bathing); the member is able to safely use the cane or crutch; and the functional mobility deficit can be sufficiently resolved by use of a cane or crutch.
2 Active Policies
L33791 — Walkers
J19
AETNA-CPB-0505 — Ambulatory Assist Devices: Walkers, Canes, and Crutches
Related Codes
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