A Practical Guide for Healthcare Providers
Basic Coverage Criteria
For Medicare to cover a walker, your documentation must establish that:
- The patient has a significant mobility limitation that:
- Completely prevents performing mobility-related activities of daily living (MRADLs) in the home, OR
- Creates a significant safety risk when performing these activities, OR
- Prevents completing these activities within a reasonable timeframe
- The patient can safely use the walker
- The walker will sufficiently resolve the mobility deficit
Documenting Medical Necessity
Your clinical notes should clearly document:
✓ Specific mobility limitations and their impact on daily activities ✓ Safety assessment for walker use ✓ Why a walker is the appropriate solution ✓ Patient’s weight (if prescribing heavy-duty walker) ✓ For specialized walkers, documentation of specific medical needs:
- Heavy duty walkers (E0148, E0149): Document weight >300 lbs
- Multiple braking system walkers (E0147): Document neurologic disorder or condition limiting use of one hand
- Walkers with trunk support (E0140): Document medical necessity for trunk support features
Required Elements in Clinical Notes
- Mobility Assessment
- Specific activities patient struggles with
- Safety concerns during mobility
- Falls history (if applicable)
- Distance patient can walk without assistance
- Physical Assessment
- Balance evaluation
- Strength assessment
- Coordination
- Upper body strength/ability to use walker
- Home Assessment
- Living situation
- Home layout considerations
- Caregiver availability (if relevant)
Common Documentation Errors to Avoid
❌ Vague statements like “patient needs walker” without specific functional limitations
❌ Missing documentation of safety assessment
❌ Incomplete documentation when prescribing specialized walkers
❌ No documentation of weight for heavy-duty walker orders
❌ Failing to document why a standard walker isn’t sufficient when ordering specialized versions
Practical Documentation Tips
- Use Specific Language “Patient cannot safely walk to bathroom (40 feet) without assistance due to severe osteoarthritis of both knees causing instability” is better than “Patient has trouble walking”
- Document Functional Impact Describe how mobility limitations affect specific daily activities:
- Personal hygiene
- Toileting
- Kitchen activities
- Essential household tasks
- Include Safety Assessments Document both:
- Risks without the walker
- Patient’s ability to safely use the walker
- Special Features Documentation When prescribing walkers with special features:
- Clearly state why standard walker is insufficient
- Document specific medical necessity for each special feature
- Include supporting clinical findings
- Follow-up Documentation
- Document continued need at follow-up visits
- Note any issues or adjustments needed
- Record benefits/improvements in mobility
Medicare Documentation Checklist
✓ Completed Standard Written Order (SWO) with:
- Patient’s name
- Detailed description of walker and accessories
- Signature and date
- NPI number
✓ Clinical notes documenting medical necessity ✓ Physical assessment findings ✓ Safety evaluation ✓ For specialized walkers: specific medical justification ✓ Weight documentation (for heavy-duty walkers)
Remember
- Documentation must be completed BEFORE submitting the order
- Keep copy of all documentation in patient’s medical record
- Respond promptly to any additional documentation requests
- Review documentation requirements periodically for updates
For specific questions about coverage criteria or documentation requirements, consult your DME MAC contractor or reference LCD L33791 and Article A52503.
