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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.

Leg Extensions

  • The patient’s height is greater than or equal to 6 feet.

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