Canes and crutches 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.
The MRADLs to be considered in this and all other statements in this policy are toileting, feeding, dressing, grooming, and bathing performed in customary locations 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 an MRADL; or,
- Prevents the beneficiary from completing the MRADL within a reasonable time frame;
And,
- The beneficiary is able to safely use the cane or crutch; and,
- The functional mobility deficit can be sufficiently resolved by use of a cane or crutch.
If all of the criteria are not met, the cane or crutch will be denied as not reasonable and necessary.
The medical necessity for an underarm, articulating, spring assisted crutch (E0117) has not been established; therefore, if an E0117 is ordered, it will be denied as not reasonable and necessary.