CRUTCHES

Coverage Guidelines

Canes and crutches are covered if all of the following criteria (1-3) are met:

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1.   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.

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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.

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A mobility limitation is one that:

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• 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,

2.   The beneficiary is able to safely use the cane or crutch; and,

3.   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.