RETIRED - Walker Unbundling Billing for Brakes

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

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
E0130 A4636, A4637
E0135 A4636, A4637
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
E0148 A4636, A4637
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/

Publication History

Date of Change Description
10/18/2013 Originally Published
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