Canes and Crutches:

Aetna considers canes and crutches medically necessary durable medical equipment (DME) for members with conditions causing impaired ambulation, and there is a potential for ambulation.

Consistent with Medicare policy, Aetna does not consider axillary (under-arm), articulated, spring-assisted crutches medically necessary because the clinical value of these specialized crutches have not been established.

Standard Walkers:

Aetna considers a standard walker and related accessories medically necessary DME if both of the following criteria are met:

1. The member has a medical condition impairing ambulation and there is a potential for ambulation; and
2. There is a need for greater stability and security than provided by a cane or crutches.

A standard walker may include wheels and glide-type brakes.  A wheeled walker is one with 2, 3, or 4 wheels.  The wheels may be fixed or swivel.  It may be fixed height or adjustable height.  It may or may not include glide-type brakes (or equivalent).

A glide-type brake consists of a spring mechanism (or equivalent), which raises the leg post of the walker off the ground when the member is not pushing down on the frame.

Pediatric Walkers and Crawlers:

Aetna considers pediatric crawlers medically necessary DME for disabled children.

The Mulholland Walkabout is a walker with 4 wheels and attached back brace.  Aetna considers the Mulholland Walkabout medically necessary DME for children who have impaired ambulation and who lack trunk stability and balance.

Note: Aetna does not cover standard strollers because they do not meet Aetna's contractual definition of covered DME in that they are not primarily medical in nature and they are normally of use in the absence of illness or injury.

Specially adapted strollers may be considered medically necessary DME when they are used in place of a wheelchair for children.  See CPB 0271 - Wheelchairs and Power Operated Vehicles (Scooters).

Heavy-duty Walker:

A heavy-duty walker is one that is labeled as capable of supporting members who weigh more than 300 pounds.  It may be fixed height or adjustable height.  It may be rigid or folding.  A heavy-duty walker is considered medically necessary DME for members who meet medical necessity criteria for a standard walker and who weigh more than 300 pounds.

A heavy-duty walker may include wheels and glide-type brakes.  A wheeled walker is one with 2, 3, or 4 wheels.  The wheels may be fixed or swivel.  It may be fixed height or adjustable height.  It may or may not include glide-type brakes (or equivalent).  A glide-type brake consists of a spring mechanism (or equivalent), which raises the leg post of the walker off the ground when the member is not pushing down on the frame.

Heavy-duty, Multiple Braking System, Variable Wheel Resistance Walker:

A heavy-duty, multiple braking system, variable wheel resistance walker is considered medically necessary DME for members who meet medical necessity criteria for a standard walker and who are unable to use a standard walker due to a severe neurological disorder or other condition causing the restricted use of 1 hand.  Obesity, by itself, is not considered a medically necessary indication for this walker.

Note: For purposes of this policy, a “heavy-duty, multiple braking system, and variable wheel resistance walker” is a 4-wheeled, adjustable height, folding-walker that has all of the following characteristics:

1. At least 2 wheels have brakes that can be independently set through tension adjustability to give varying resistance, and
2. Capable of supporting individuals who weigh greater than 350 pounds, and
3. Hand operated brakes that cause the wheels to lock when the hand levers are released, and
4. The hand brakes can be set so that either or both can lock the wheels, and
5. The pressure required to operate each hand brake is individually adjustable, and
6. There is an additional braking mechanism on the front crossbar

Walker with Enclosed Frame:

A walker with enclosed frame is a folding wheeled walker that has a frame that completely surrounds the member and an attached seat in the back.  Aetna does not cover walkers with enclosed frames because their medical necessity compared to a standard folding wheeled walker has not been established.

Roll-A-Bout Walker/the Turning Leg Caddy Knee Walker:

Aetna considers an iWALKFree, Rolleraid, Roll-A-Bout Walker and the Turning Leg Caddy Knee Walker medically necessary DME where a member can not use crutches, standard walkers or other standard ambulatory assist devices (e.g., a member with an injured foot can not use crutches because he/she has only 1 arm).

Enhancement Accessories:

Aetna does not cover enhancement accessories of walkers, canes and crutches as these are considered convenience items.  An enhancement accessory is one that does not contribute significantly to the therapeutic function of the walker, cane or crutch.  It may include, but is not limited to style, color, hand operated brakes (other than those described in the section above on heavy duty, multiple braking system, variable wheel resistance walker), seat attachments, tray attachments, baskets or cup holders (or equivalent).

Leg Extensions:

Leg extensions are considered medically necessary DME for members 6 feet tall or more.

Arm Rests:

Arm rest attachments are considered medically necessary DME when the member's ability to grip is impaired.

Walking Belts:

Note: Aetna does not cover walking belts (belts used to support and guide the member in walking) because they do not meet Aetna's contractual definition of DME in that they are not primarily medical in nature and they are normally of use to persons who do not have a disease or injury.

Gait Trainers: The Rifton Gait Trainer/Pacer Gait Trainer, The KidWalk Gait Mobility System, and the Therapeutic Ambulatory Orthotic System (TAOS):

Aetna considers the Rifton Gait Trainer/Pacer Gait Trainer medically necessary DME for children and adults who require moderate to maximum support for walking and who are capable of walking with this device.

The Rifton Gait Trainer is a type of walker, which provides considerable postural support for the user.  It comes in a range of sizes that caters for tiny children through to adults.  Each size has a range of adjustable features that can be adjusted to meet individual needs.  This walker has been superceded by the Pacer Gait Trainer, which is a redesign of the Rifton Gait Trainer.  It is suitable for children and adults who require moderate to maximum support for walking.  The fame is made of aluminum.  The large castors offer a range of functions -- gradual brake/drag, brake lock, swivel, swivel lock and 1-way ratchet control.  This gives a wide range of control in speed, direction and maneuverability.  Three sizes are available -- user elbow heights from 44.5 to 119.5 cm.

Aetna considers the KidWalk Gait Mobility System and the Therapeutic Ambulatory Orthotic System (TAOS) medically necessary DME for children who require moderate to maximum support for walking and are capable of walking with these devices.

The TAOS is an orthotic and a walker base.  According to the manufacturer, these 2 components work together to provide a child with cerebral palsy an upright hands-free environment.  The manufacturer states that the orthotic guides the child into proper alignment so they can train the proper muscles.  The base holds the child in a standing position and provides security for them to explore and improve.

Wearable Freezing of Gait Detection System:

Aetna considers the use of a wearable freezing of gait detection system for assisting walking of individuals with Parkinson's disease experimental and investigational because of insufficient evidence in the peer-reviewed literature.

Autoambulators

Aetna considers the Autoambulator experimental and investigational because the clinical evidence is not sufficient to permit conclusions on the health outcome effects of the Autoambulator. 

This policy is based, in part, upon Medicare DMERC Local Medical Policy.

Approximately 50 % of the patients with advanced Parkinson's disease (PD) suffer from freezing of gait (FOG), which is a sudden and transient inability to walk.  It often causes falls, interferes with daily activities and significantly impairs quality of life.  Because gait deficits in PD patients are often resistant to pharmacotherapies, effective non-pharmacotherapiess are of special interest.  Bachlin and colleagues (2010) evaluated the concept of a wearable device that can obtain real-time gait data, processes them and provides assistance based on pre-determined specifications.  This wearable system uses on-body acceleration sensors to measure the patients' movements.  It automatically detects FOG by analyzing frequency components inherent in these movements.  When FOG is detected, the assistant provides a rhythmic auditory signal that stimulates the patient to resume walking.  These investigators evaluated their wearable assistive technology in a study with 10 PD patients.  Over 8 hours of data were recorded and a questionnaire was filled out by each patient.  A total of 237 FOG events have been identified by professional physiotherapists in a post-hoc video analysis.  The device detected the FOG events online with a sensitivity of 73.1 % and a specificity of 81.6 % on a 0.5-sec frame-based evaluation.  The authors concluded that these findings showed that online assistive feedback for PD patients is possible.  They stated that their results demonstrated the benefit of such a context-aware system and motivated further studies.

The Autoambulator is a therapeutic robotic machine developed to rehabilitate individuals recovering from conditions affecting walking such as stroke, spinal cord injury, and hip or knee replacement surgery. The AutoAmbulator features an overhead harness system to fully support the patient, mechanically powered braces to move the patient's legs, and numerous computerized sensors to track vital signs, movement, and contact speed, adjusting speed accordingly. Researchers are evaluating the AutoAmbulator's ability to increase blood flow in patients' legs, decrease muscle spasms, and improve respiration and circulatory function.

According to Winchester and Querry, 2006, robotic orthoses for body weight-supported treadmill training (BWSTT) has become an accepted standard of care in gait rehabilitation methods. This type of locomotor training has many functional benefits, but the physical labor costs are considerable. To reduce therapist effort and improve the repeatability of locomotor training, three groups have developed commercially available robotic devices for assisted stepping. The purpose of these robotic devices is to augment locomotor rehabilitation by decreasing therapist manual assistance, increasing the amount of stepping practice, while decreasing therapist effort. Current clinical studies have yielded positive and promising results in locomotor rehabilitation inpatients with neurologic impairments of stroke or SCI. The potential benefits from robotic technology are significant for clinical use and research. As further research is conducted, rehabilitation therapists and patient outcomes will be able to contribute to the development of current and future technologies