Article Detail - JD DME
RETIRED - Walker Unbundling Billing for Brakes
Posted October 18, 2013
The DME MACs have recently identified an unbundling issue related to walkers (E0141, E0143, and E0149) and brake attachments (E0159). This article provides clarification on when it is appropriate to bill the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) separately for walkers and brake attachments.
Upon initial issue of an E0141, E0143, and E0149, if brakes are being provided at the same time, the charges are included in the reimbursement for the walker and may not be billed separately to the DME MACs or the beneficiary. The following table can be found in the Walkers policy article; please note the status of the brake attachments (E0159):
A Column II code is included in the allowance for the corresponding Column I code when provided at the same time and must not be billed separately at the time of billing the Column I code.
|COLUMN I||COLUMN II|
|E0140||A4636, A4637, E0155, E0159|
|E0141||A4636, A4637, E0155, E0159|
|E0143||A4636, A4637, E0155, E0159|
|E0144||A4636, A4637, E0155, E0156, E0159|
|E0147||A4636, E0155, E0159|
|E0149||A4636, A4637, E0155, E0159|
Below is a reference regarding each HCPCS code and narrative description for the above table:
|HCPCS Code||Narrative Description|
|A4636||REPLACEMENT, HANDGRIP, CANE, CRUTCH, OR WALKER, EACH|
|A4637||REPLACEMENT, TIP, CANE, CRUTCH, WALKER, EACH.|
|E0130||WALKER, RIGID (PICKUP), ADJUSTABLE OR FIXED HEIGHT|
|E0135||WALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIGHT|
|E0140||WALKER, WITH TRUNK SUPPORT, ADJUSTABLE OR FIXED HEIGHT, ANY TYPE|
|E0141||WALKER, RIGID, WHEELED, ADJUSTABLE OR FIXED HEIGHT|
|E0143||WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT|
|E0144||WALKER, ENCLOSED, FOUR SIDED FRAMED, RIGID OR FOLDING, WHEELED WITH POSTERIOR SEAT|
|E0147||WALKER, HEAVY DUTY, MULTIPLE BRAKING SYSTEM, VARIABLE WHEEL RESISTANCE|
|E0148||WALKER, HEAVY DUTY, WITHOUT WHEELS, RIGID OR FOLDING, ANY TYPE, EACH|
|E0149||WALKER, HEAVY DUTY, WHEELED, RIGID OR FOLDING, ANY TYPE|
|E0155||WHEEL ATTACHMENT, RIGID PICK-UP WALKER, PER PAIR|
|E0159||BRAKE ATTACHMENT FOR WHEELED WALKER, REPLACEMENT, EACH|
Note: HCPCS code E0159 (Brake attachment for wheeled walker, replacement each) is applicable for replacement brakes ONLY.
An Advance Beneficiary Notice of Noncoverage (ABN) should not be executed to shift financial liability to the beneficiary for brakes provided at the same time the walker is dispensed.
Refer to the Walkers LCD and related Policy Article for additional information about coverage, documentation and coding requirements.
For questions about correct coding, contact the PDAC Contact Center at 877-735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC web site: http://www.dmepdac.com/
|Date of Change||Description|
|04/01/2021||Retired due to content incorporation into the applicable Local Coverage Determination-related Policy Article|
Last Updated Thu, 01 Apr 2021 16:34:36 +0000