How To Guide: Billing Walkers, Rollators, and Brake Attachments

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The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have issued a reminder to DME suppliers regarding the correct billing of walkers, rollators, and brake attachments. This guide explains when it is appropriate to bill the DME MACs separately for walkers and brake attachments.

Two Codes, Big Difference

Many “rollator” types of walkers are manufactured with a seat for the beneficiary to use when feeling tired or unsteady. According to the PDAC Contractor, suppliers may bill two codes for this walker: the E0143 (wheeled walker) and the E0156 (seat attachment).

two elderly women sitting in walkers

The Policy Article (A52503) for Walkers states that the E0143 is coded to include glide-type brakes or equivalent. This braking system uses a spring mechanism which causes the walker leg post to release when there is no downward pressure applied to the top of the walker frame. Instead of the glide-type brakes, many “rollator” walkers have a hand braking system that is comparable in nature to that of brakes on a bicycle. This hand braking system is considered an enhancement accessory that does not contribute to the overall function of the walker. Therefore, suppliers may bill for this variable braking system using HCPCS code A9270.

Billing Baskets & Accessories

Other enhancement accessories, such as a basket or special color combination, may also be billed using HCPCS A9270, which will result in a Patient Responsibility (PR) denial on that particular claim line.

For reference, here is the excerpt from the related Policy Article for Walkers:

An enhancement accessory is one which does not contribute significantly to the therapeutic function of the walker. It may include but is not limited to style, color, hand operated brakes (other than those described in code E0147), or basket (or equivalent). Use code A9270 when an enhancement accessory of a walker is billed.

The following is an example of the HCPCS codes a supplier might bill the Medicare program for a rollator walker with basket and hand braking system:

  • E0143NUKX
  • E0156NUKX
  • A9270 (with a narrative in the NTE segment indicating the hand brakes)
  • A9270 (with a narrative in the NTE segment indicating basket addition)

When the claim is processed, the E0143 and the E0156 will be considered for coverage while the two A9270 line items will deny PR and the beneficiary will be responsible for payment.

Billing for Brakes

Upon initial concern 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:

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

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 being provided at the time the walker is dispensed.

 

Written by: Kelsey Payette, Prometheus Account Manager

 

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