Canes, crutches, walkers and gait trainers are used to assist individuals with safe ambulation.
The following providers may provide ambulatory assist equipment:
• Federally Qualified Health Centers
• Home health agencies
• Indian Health Services
• Medical suppliers
• Rural Health Clinic
• Physician and clinics (may supply crutches only)
Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare in order to help members for whom MHCP is not the primary payer.
MHCP quantity limits and thresholds apply to all members unless only Medicare coinsurance or deductible is requested.
Ambulatory assist equipment is covered for eligible MHCP members who meet medical necessity criteria. The following restrictions apply for members in a nursing facility or Intermediate Care Facility for persons with developmental disabilities (ICF/DD):
• Canes: not covered for members in nursing facilities or an ICF/DD.
• Walkers: not covered for members in nursing facilities. Only walkers with trunk support are covered for members in an ICF/DD.
• Gait trainers: may be covered for members in nursing facilities or an ICF/DD.
E0110-E0118, E0153: Crutches
E0130-E0149, E0154-E0159: Walkers
E8000-E8002: Pediatric size gait trainers
Canes are covered for members who are unable to safely ambulate in one or more locations they routinely access due to a temporary or permanent medical condition.
• MHCP does not require that the cane is needed in the home. Canes are also covered for members who are able to safely ambulate in the home, but who require a cane for stability in the community.
• MHCP covers a cane for members who primarily use walkers or wheelchairs, but who require a cane in specific situations.
• MHCP defers to the prescribing and dispensing professionals regarding what kind of cane is required (E0100 or E0105).
Crutches are covered for members who are unable to safely ambulate in one or more locations they routinely access due to a temporary or permanent medical condition.
• When dispensing two crutches, use the HCPCS code for a pair, not two units of individual crutches
• Use the HCPCS code for an individual crutch when replacing one of a pair of crutches
• When dispensing articulating, spring assisted crutches, providers must maintain documentation as to why standard crutches will not meet the member’s needs
• Rental of a crutch substitute is covered for members who are unable to safely use standard crutches
Walkers are covered for members who are unable to safely ambulate in one or more locations they routinely access due to a temporary or permanent medical condition.
• MHCP does not require that the walker is needed in the home. Walkers are also covered for members who are able to safely ambulate in the home, but who require a walker for safety in the community.
• MHCP covers a walker for members who primarily use wheelchairs, but who require a walker in specific situations.
• A heavy-duty walker is covered if a member’s weight, body size or stability makes a standard walker unsafe.
• Because very few walkers are made for children, DHS will allow manual pricing of pediatric walkers. Authorization is required if the expected payment exceeds the fee schedule rate.
• A wheeled walker is assumed to include glide-type brakes which raise the leg post of the walker off the ground when the patient is not pushing down on the frame. If dispensing a walker with hand brakes, providers may bill E0159 as a replacement for glide-type brakes.
• Bill Medicare for replacement for only original glide-type brakes. Medicare does not pay for hand brakes. For new walkers, if the member needs hand brakes, bill Medicare for only the walker and bill MHCP for the hand brakes.
• Reverse walkers are considered medically necessary for members who cannot safely use a standard walker. Use the walker code that most appropriately describes the item, not a miscellaneous code. Prior authorization is required when the expected payment exceeds the fee schedule rate. Include modifier U3 when requesting prior authorization. Documentation must establish that the member’s medical needs cannot be safely met using a standard walker, and that the requested walker is the least costly alternative to appropriately meet the person’s needs.
• Only walkers coded by the PDAC may be billed as E0147.
Gait trainers are covered with prior authorization for members who require moderate to maximum support to walk, and who require the equipment to establish or maintain functional gait. Documentation must include:
• Member’s age, height, weight and current level of mobility
• A physical therapy evaluation with baseline measurements, functional goals and recommendations for an assistive device to support gait training and ambulation, as well as any history of gait training and devices used
• A specific therapy program detailing the frequency and duration of sessions during which the member will use the device
• Training given to the caretakers to assure that the device is used appropriately
• Results of a trial in the locations where the person is expected to use the device
• Less costly alternatives considered and why they were rejected (include specific product information)
Submit the HCPCS code for the requested gait trainer. Include a list of all accessories with documentation of medical necessity for each item added to the gait trainer.
• Grab bars or wall rails
• Portable or installed ramps
• White canes for the blind
Authorization is required when the expected payment for a pediatric or reverse walker exceeds the fee schedule rate as described in the walker subsection for accessories for previously purchased gait trainers when the submitted charge is over $400, and for all gait trainers.
When authorization is required, list all requested parts and accessories on the authorization request. If approved, the approved rate will include all requested and approved parts and accessories.
Submit authorization requests through MN–ITS (authorization request 278). Fax the MN–ITS response with the required documentation and physician’s order to the authorization medical review agent. Document the MN–ITS Authorization Request number assigned on every page of each document.
For paper authorization, fax or mail the required documentation, physician’s orders and the MHCP Authorization form (DHS-4695) (PDF) to the authorization medical review agent.
Attach the manufacturer’s invoice, a price list, or a quote from the manufacturer dated within three months of the authorization request. Clearly indicate each item being requested. Do not modify, alter or change the pricing documentation.
Gait trainers are reviewed as a complete package. The approved rate for purchase of a gait trainer will include all approved accessories.
• Use MN–ITS 837P Professional. Refer to the MN–ITS User guide for DME/Med Supply/Prosthetics/Orthotics for billing instructions.
• Bill all ambulatory assist equipment using the most appropriate HCPCS code. Do not use a miscellaneous code regardless of special features or weight capacity.
• Use A9999 for accessories for previously purchased gait trainers.
• The HCPCS code and modifiers must match the authorization
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