Physician Documentation Requirements
- Detailed Written Order That Contains:
- Patient's Name
- Detailed Description of the Item(s) to Be Ordered
- Length of Need the Patient Will Require the Item(s)
- Physician's Printed Name
- Physician's NPI
- Physician's Signature
- Physician's Date of Signature
- Face-to-face evaluation dated within 6 months of the detailed written order documenting:
- Patient's diagnoses or conditions that warrant the medical necessity of the item,
- And all of the following criteria 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 by use of a walker.
Heavy Duty Walker
- The patient meets all coverage criteria for a walker (above) and weighs more than 300 pounds.
Heavy Duty, Multiple Braking System, Variable Wheel Resistance Walker
- The patient meets coverage criteria for a walker and medical records document that the patient is unable to use a standard walker due to a severe neurologic disorder or other condition causing the restricted use of one hand.
Walker with Trunk Support
- The patient meets all coverage criteria for a walker and documentation in the medical record justifies the medical necessity for the special features.
- The patient’s height is greater than or equal to 6 feet.