Gait Trainers
What to think about when determining the appropriate gait trainer for your child
School therapists are able to write the LMN for the gait trainer, if the gait trainer is going to be used in school.
Keep in mind that gait trainers are quite bulky. Is there enough space in the child’s home to accommodate this product? Will the family be able to transport the gait trainer?
Gait trainers either require hands and arms for support OR they can be hands free.
If the child is able-hands free is preferred as it increases their access to more environments by being able to walk right up to tables, counters and their peers, allows them to engage in more activities and use their hands while supported upright.
Has your child been successful in standing upright? Do they press up through their feet when positioned in supported standing?
In order to shower a successful trial of a gait trainer, a child needs to be able to take a step. If your child is not able to tolerate or engage in upright standing just yet, maybe a standing frame would be more appropriate at this time.
Please consider that insurance will not cover a standing frame and a gait trainer within a 5-year period as they are both seen as “weight bearing” devices.
Gait trainers to consider
Sample letters of medical necessity
Medicaid general guidelines
Clinical documentation from a trial period must be submitted with the prior approval request.
The member is unable to stand or ambulate independently due to conditions such as, but not limited to, neuromuscular or congenital disorders, including acquired skeletal abnormalities.
The alignment of the member’s lower extremities are such that they can tolerate a standing or upright position.
The member does not have orthostatic hypotension, postural tachycardia syndrome, osteogenesis imperfecta, osteoporosis and other brittle bone diseases.
The member has demonstrated improved mobility, function and physiologic symptoms or has maintained ambulation status with the use of the requested gait trainer (when other alternatives have failed) and is able to follow a home ambulation program incorporating the use of the gait trainer (as documented by clinical ambulation program or home trial with the requested gait trainer).
The member does not utilize, or require, a home standing device in addition to a walker or gait trainer. Provision of both a standing system and walker/gait trainer is typically considered a duplication of service, as both address weight bearing.
Per Medicaid guidelines a detailed letter of medical necessity (LMN) that includes (in check list above too):
A comprehensive history and physical exam by a licensed physician, physical therapist or occupational therapist.
A summary of the existing medical condition, age at diagnosis, prognosis and co-morbid conditions.
The member’s functional and physical assessment including strength, range of motion, tone, sensation, balance, ADLs, and functional status.
Documentation of failure of less costly alternatives (include make and model of alternatives tried as well as the length of the trial with each alternative).
A home therapy plan outlining the planned use of the requested gait trainer
Documentation that the member does not have sufficient access to equipment in an alternative setting, e.g., clinic, outpatient therapy, etc.
Documentation regarding the level of caregiver assistance available/needed on daily basis.
Documentation that the member’s home can accommodate the requested gait trainer and that the family/caregiver has been trained in the use and maintenance of the requested gait trainer.