From the Guidelines
To document a rollator walker for Medicare approval in a patient with osteoarthritis of the knees and hip who currently uses a cane, a detailed medical necessity statement is required, including the patient's diagnosis, current mobility limitations, and need for additional support due to worsening symptoms, as supported by the 2019 American College of Rheumatology guideline 1. The documentation should include the patient's diagnosis of osteoarthritis affecting multiple joints (knees and hip), specifically noting ICD-10 codes such as M17.9 for knee osteoarthritis and M16.9 for hip osteoarthritis.
- Document that the patient currently requires a cane but has progressed to needing additional support due to worsening pain, instability, or fall risk, as cane use is strongly recommended for patients with knee and/or hip OA in whom disease in 1 or more joints is causing a sufficiently large impact on ambulation, joint stability, or pain to warrant use of an assistive device 1.
- Include objective findings from a physical examination showing decreased range of motion, pain with weight-bearing, gait instability, or other functional limitations.
- Specify that the patient requires the rollator for mobility within the home (this is crucial for Medicare coverage) and that the device is necessary for activities of daily living.
- Note any failed conservative treatments, such as weight loss, exercise programs, self-efficacy and self-management programs, tai chi, yoga, or cognitive behavioral therapy, and why a cane is no longer sufficient. Medicare typically requires that the rollator be prescribed by a physician with supporting documentation from physical therapy evaluations if available, as the device is considered durable medical equipment (DME) and requires clear evidence that it is medically necessary, not just convenient, and that less costly alternatives (like the current cane) are insufficient for safe mobility.
From the Research
Documentation Requirements for Medicare Approval
To obtain Medicare approval for a rollator walker for a patient with osteoarthritis of the knees and hip, the following documentation is necessary:
- A thorough medical evaluation and diagnosis of osteoarthritis, including the patient's medical history, current symptoms, and treatment plan 2
- Documentation of the patient's current mobility status, including their ability to ambulate with a cane and any limitations or difficulties they experience 3
- An assessment of the patient's need for a rollator walker, including their balance, upper body strength, and dexterity 3
- A prescription for a rollator walker from a qualified healthcare professional, including the patient's name, the type of device prescribed, and the medical reason for the prescription 3
Medical Necessity
To establish medical necessity for a rollator walker, the patient's healthcare provider must document that:
- The patient has a medical condition that requires the use of a mobility assistive device, such as osteoarthritis of the knees and hip 2
- The patient is unable to ambulate safely without the use of a mobility assistive device, such as a cane or rollator walker 3
- The patient has tried other treatments, such as exercise therapy and physical modalities, and has not achieved sufficient relief from symptoms 4, 5, 6
Additional Considerations
When documenting the medical necessity for a rollator walker, the healthcare provider should also consider the following:
- The patient's ability to use the device safely and effectively, including their balance, upper body strength, and dexterity 3
- The patient's lifestyle and living situation, including their home environment and ability to navigate stairs or other obstacles 3
- The patient's overall health and medical status, including any comorbidities or other medical conditions that may affect their ability to use a rollator walker 2