Cane/Crutch Documentation Needs
The following qualification criteria need to be documented in the patients’ medical record notes to qualify for the prescribed equipment. Note: Justification notes are valid for six months.

All of the following need to be sufficiently documented to support the need for the prescribed equipment.

  • Explain the patients mobility limitation that significantly impairs (His or Her) ability to participate in one or more mobility-related activities of daily living (MRADL) in the home
  • Explain the patient’s ability to safely use the cane or crutch
  • Explain how the patient’s functional mobility deficit will be sufficiently resolved by the use of a cane or crutches

Diagnosis: See LCD (Local coverage determination) at NGSMedicare.com for any additional qualifying information questions, diagnosis codes and descriptions

Medicare approved detailed equipment descriptions for canes and crutches (does not have to be exact)
Cane, adjustable or fixed, single point, (HCPC- E0100)
Cane, adjustable or fixed, single point, heavy duty, (HCPC-E0100)
Cane, quad or 3 prong, adjustable or fixed, large base, (HCPC-E0105)
Cane, quad or 3 prong, adjustable or fixed, small base, (HCPC-E0105)
Cane, quad or 3 prong, adjustable or fixed, heavy duty, (HCPC-E0105)
Crutches underarm, adjustable with pad, tips and hand grips- pediatric, (HCPC-E0114)
Crutches underarm, adjustable with pad, tips and hand grips- Youth, (HCPC-E0114)
Crutches underarm, adjustable with pad, tips and hand grips- Adult, (HCPC-E0114)
Crutches underarm, adjustable with pad, tips and hand grips- Tall adult, (HCPC- E0114)
Crutches underarm, adjustable with pad, tips and hand grips- heavy duty, (HCPC- E0114)
Crutches underarm, adjustable with pad, tips and hand grips- heavy duty tall , (HCPC- E0114)

Patient notes/justification – Must be documented using normal dictation processes. Letters of medical necessity, notes wrote on letter head or prescriptions are not valid.

Prescription/order requirements – Must contain Patients name, date of the order and Start date, detailed equipment description (See above), signature of the ordering physician and a signature date.