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.

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 four 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 271 - Wheelchairs.

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

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:

Aetna considers a Roll-A-Bout Walker medically necessary DME where a member can't use crutches, standard walkers or other standard ambulatory assist devices (e.g., a member with an injured foot can't use crutches because he/she has only one 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, or baskets (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 durable medical equipment 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.

The Rifton Gait Trainer/Pacer Gait Trainer:

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 one-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.

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