For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity.
A standard walker and related accessories are covered if all of the following criteria (1-3) are met:
1. The beneficiary 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 beneficiary from accomplishing the MRADL entirely, or
2. Places the beneficiary at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform the MRADL, or
3. Prevents the beneficiary from completing the MRADL within a reasonable time frame; and
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.
If all of the criteria are not met, the walker will be denied as not reasonable and necessary.
A heavy duty walker is covered for beneficiaries who meet coverage criteria for a standard walker and who weigh more than 300 pounds. If an or walker is provided and if the beneficiary weighs 300 pounds or less, it will be denied as not reasonable and necessary.
A heavy duty, multiple braking system, variable wheel resistance walker is covered for beneficiaries who meet coverage criteria for a standard walker and who are unable to use a standard walker due to a severe neurologic disorder or other condition causing the restricted use of one hand. Obesity, by itself, is not a sufficient reason for an walker. If an walker is provided and if the additional coverage criteria are not met, it will be denied as not reasonable and necessary.
The medical necessity for a walker with an enclosed frame has not been established. Therefore, if an enclosed frame walker is provided, it will be denied as not reasonable and necessary.
A walker with trunk support is covered for beneficiaries 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 if the medical record does not document why that item is medically necessary, it will be denied as not reasonable and necessary.
Leg extensions are covered only for beneficiaries 6 feet tall or more.