HCPCS E0135: Walker, folding, adjustable or fixed height

## **HCPCS code E0135 documentation requirements** Before delving into the documentation requirements for billing, do note that according to Medicare, the following are criteria, from the local coverage determination, is covered if all of the following criteria are met: - The beneficiary 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. **Note**: Mobility limitations are ones that prevents the beneficiary from accomplishing the MRADL entirely, prevents the beneficiary from completing the MRADL within a reasonable time frame, or places the beneficiary at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform the MRADL - The beneficiary is able to safely use the walker - The functional mobility deficit can be sufficiently resolved with use of a walker Moving on to the documentation requirements. Coverage for DME items like E0135 generally requires documentation or medical records justifying medical necessity. While specific payer policies may vary, key documentation typically includes: - **Physician order/prescription**: A clear, written order from the prescribing physician (MD, DO, or other authorized practitioner) that includes the patient's name, the date of the order, a description of the item (e.g., "folding walker"), the length of need (e.g., "lifetime" or a specified period), and the physician's signature and date. - **Medical record documentation**: Notes from the treating physician or other medical professional must justify the need for the walker. This usually includes: the patient's mobility impairment that prevents ambulation with a lesser device (like a cane) or without assistance, verification that the patient is capable of using the device (e.g., adequate upper body strength and balance), the diagnosis or condition that necessitates the walker, and a clinical note from a recent visit. - **Proof of Delivery (POD)**: Documentation from the supplier showing the date the walker was delivered to the beneficiary. - **Advance Beneficiary Notice of Non-Coverage (ABN) / waiver**: If the supplier believes Medicare may deny the claim (e.g., lack of medical necessity), a signed ABN must be obtained from the patient before delivery.

## **E0135 billing requirements** To ensure that HCPCS code E0135 is billed accordingly, the following requirements must be met: - **Type of service**: E0135 can be billed for either the purchase or rental of the equipment, depending on payer policy and the length of medical necessity. - **Modifiers**: Essential modifiers are used to clarify the claim such as NU (New Equipment), RR (Rental), UE (Used Equipment), KX (Documentation on File), etc. - **Claim submission**: Claims are submitted to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) for Medicare beneficiaries. - **Unit of service**: Typically billed as "each" (one unit per item). - **Coverage limitations**: Payer policies often specify frequency limits (how often the item can be replaced) and whether accessories are separately billable (see Related Codes).

## **Other related codes** - **E0130:** Rigid pick up walker, adjustable or fixed height - **E0141**: Walker, rigid, wheeled, adjustable or fixed height - **E0143**: Walker, folding, wheeled, adjustable or fixed height - **E0144**: rigid or folded wheeled walker, enclosed, four sided frame, with posterior seat - **E0140**: Walker, with trunk support, adjustable or fixed height, any - **E0147**: Variable wheel resistance walker (usually a rollator), multiple braking system, heavy duty - **E0148**: Heavy duty walker, without wheels, rigid or folding, any type, each