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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that a standard walker (E0130, E0135, E0141, E0143) and related accessories are covered if all of 
the following criteria (1-3) 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. 
 
    A mobility limitation is one that: 
 
        Prevents the beneficiary from accomplishing the MRADL entirely, or 
 
        Places the beneficiary at reasonably determined heightened risk of morbidity or mortality secondary to the 
attempts to perform the MRADL, or 
 
        Prevents the beneficiary from completing the MRADL within a reasonable time frame; and 
 
    The beneficiary is able to safely use the walker; and 
    The functional mobility deficit can be sufficiently resolved with use of a walker. 
 
 If all of the criteria are not met, the walker will be denied as not reasonable and necessary. 
 
A heavy duty walker (E0148, E0149) is covered for beneficiaries who meet coverage criteria for a standard 
walker and who weigh more than 300 pounds. If an E0148 or E0149 walker is provided and if the beneficiary 
weighs 300 pounds or less, it will be denied as not reasonable and necessary. 
 
A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted. If the 
supplier bills for an item addressed in this policy without first receiving a completed SWO, the claim shall be 
denied as not reasonable and necessary. 
 
For Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) base items that require a 
Written Order Prior to Delivery (WOPD), the supplier must have received a signed SWO before the DMEPOS 
item is delivered to a beneficiary. If a supplier delivers a DMEPOS item without first receiving a WOPD, the 
claim shall be denied as not reasonable and necessary. Refer to the LCD-related Policy Article, located at the 
bottom of this policy under the Related Local Coverage Documents section. For DMEPOS base items that require a WOPD, and also require separately billed associated options, 
accessories, and/or supplies, the supplier must have received a WOPD which lists the base item and which may 
list all the associated options, accessories, and/or supplies that are separately billed prior to the delivery of the 
items. In this scenario, if the supplier separately bills for associated options, accessories, and/or supplies 
without first receiving a completed and signed WOPD of the base item prior to delivery, the claim(s) shall be 
denied as not reasonable and necessary. 
 
An item/service is correctly coded when it meets all the coding guidelines listed in CMS HCPCS guidelines, 
LCDs, LCD-related Policy Articles, or DME MAC articles. Claims that do not meet coding guidelines shall be 
denied as not reasonable and necessary/incorrectly coded. 
 
You can find these rules in the Local Coverage Determination (LCD) Walkers L33791. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.