WALKER UNBUNDLING BILLING FOR BRAKES


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 for these 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 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 non-coverage (ABN) should not be executed to shift financial liability to the beneficiary for brakes being provided at the 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 website: https://www.dmepdac.com/This link takes you to an external website..

Published by Noridian as the PDAC.  Republished by Palmetto GBA as the PDAC, February 2019.  Please note that links in this document were accurate at the time of original publication and may change over time and are no longer active.



Last Updated: 10/22/2013