CurrentCareFirstPolicy N/A

Crutches and Accessories

Defines coverage stance and benefit considerations for crutches and related accessories for CareFirst members; applies to providers submitting claims and members whose coverage is governed by CareFirst contracts.

Policy Summary

PayerCareFirst

PolicyCrutches and Accessories

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review DateOct 8, 2025

Key ActionVerify member benefits and maintain medical necessity documentation; report crutches with the listed HCPCS codes and note items may be immediate needs.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

11HCPCS codes listed

1Explicitly excluded code

MostComfort/convenience items

ImmediateImmediate need status

Coverage Criteria

Covered when ALL of the following are met:

Medical necessity for ambulatory assistance: Member needs assistance with ambulation due to surgical procedure, trauma, or neurological condition (including but not limited to these)

Standard model: Requested item is a standard/basic crutch device with only components essential to functioning

Deluxe items with electrical or mechanical enhancements are not covered; underarm articulating spring-assisted crutch (E0117) is specifically excluded

Deluxe items are expressly excluded from benefits. The policy defines deluxe as devices with electrical or mechanical features that enhance basic equipment and usually serve a convenience function. The underarm, articulating, spring-assisted crutch (E0117) is specifically identified as a deluxe item and benefits are not provided for this code.

Many member contracts exclude items considered for comfort or convenience, as well as products for environmental control, furniture, exercise equipment, institutional equipment, and over-the-counter supplies available without a prescription. A provider prescription alone does not guarantee coverage; always verify the member's contract for specific benefits.

Policy Summary

PayerCareFirst

PolicyCrutches and Accessories

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review DateOct 8, 2025

Key ActionVerify member benefits and maintain medical necessity documentation; report crutches with the listed HCPCS codes and note items may be immediate needs.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Per this policy, deluxe crutches and items provided solely for comfort or convenience are not medically necessary and benefits are not provided for those items.

Coding

Covered HCPCS Codes (reporting for crutches and accessories)HCPCSCovered

A4635
A4636
A4637
E0110
E0111
E0112
E0113
E0114
E0116
E0118

1–10 of 11

1/2

Excluded HCPCS CodeHCPCSNot Covered

E0117

Underarm, articulating, spring-assisted crutch (deluxe) - excluded

Provider Actions

Billing Rule

Coding and immediate need reporting

Crutches and accessories should be reported with the listed HCPCS codes. These items are considered immediate needs and must be billed using the appropriate HCPCS codes.

Report with HCPCS: A4635, A4636, A4637, E0110, E0111, E0112, E0113, E0114, E0116, E0118, E0153
Items are considered immediate needs

Note

Benefit verification

Verify member contract benefits before providing items. A prescription does not guarantee coverage; many member contracts exclude items considered comfort/convenience, environmental control, furniture, exercise equipment, institutional equipment, or over‑the‑counter supplies.

Check member contract for specific benefits
Prescription does not guarantee coverage
Over‑the‑counter items and non‑medical supplies may be excluded

Denial Risk

Claims for items considered for comfort

Claims for items considered comfort, convenience, environmental control, furniture, exercise equipment, or institutional equipment are not covered and may be denied.

Claims for comfort/convenience/environmental control/furniture/exercise/institutional equipment are subject to noncoverage

Denial Risk

Claims for deluxe crutch model E0117 may

Claims for the deluxe underarm, articulating, spring‑assisted crutch (HCPCS E0117) may be denied because deluxe items are not covered. Deluxe items are defined as those with electrical or mechanical features that enhance basic equipment and primarily serve a convenience function.

Deluxe crutch model E0117 (underarm, articulating, spring‑assisted) is not covered
Deluxe = electrical or mechanical features that provide convenience

Documentation Required

Medical necessity documentation

Provider documentation of medical necessity may be requested and claims may be subject to medical review. Maintain complete records supporting the need for ambulatory assist devices.

Provider documentation of medical necessity may be requested
Claims may be subject to medical review

Medical Necessity

DME Medical Necessity — Crutches

Crutches are medically necessary when:

Ambulation assistance need: Member requires assistance with ambulation due to acute injury, post-surgical recovery, trauma, or neurological condition

Standard device requested: Device is a standard/basic model (not deluxe) providing essential components to regain functional ambulation

Deluxe models such as E0117 (underarm, articulating, spring-assisted) are excluded

Rental and Purchase Rules

Item	Rule	Reporting / Notes
Crutches and accessories	Considered immediate needs; no rental-to-purchase delay applies	Report with HCPCS codes A4635, A4636, A4637, E0110, E0111, E0112, E0113, E0114, E0116, E0118, E0153; provider documentation of medical necessity may be requested

Documentation Requirements

Documentation Required

Maintain and provide medical necessity documentation

Maintain and produce medical necessity documentation upon request; CareFirst may review claims and request supporting records to substantiate need.

Billing Rule

Confirm benefit eligibility before claim submission

Confirm the member's eligibility and benefits prior to submitting claims; a provider prescription does not ensure coverage under the member's contract.

Not Covered

NOT COVERED: Deluxe items (including E0117), items intended primarily for comfort or convenience, environmental control equipment, furniture, exercise equipment, institutional equipment, and over-the-counter items available without a prescription when excluded by the member contract.

Definitions

Crutch

DefinitionA device to assist in impaired ambulation, usually with a crosspiece at one end to fit under the armpit.

Typical useUsed when a member needs assistance with ambulation due to acute injury, post-surgical recovery, trauma, or neurological condition.

Model typesStandard models provide only components essential to functioning and return the individual to a functional level; deluxe models provide additional features and are not covered.

Deluxe

DefinitionElectrical or mechanical features which enhance basic equipment usually serving a convenience function.

Coverage implicationDeluxe items are not covered; additional benefits are not provided for deluxe models.

Example excluded itemUnderarm, articulating, spring-assisted crutch (E0117) is considered a deluxe item and benefits are not provided.

Background

Crutches are ambulatory assist devices used to aid ambulation when a member requires assistance following an acute injury, surgical procedure, trauma, or due to a neurological condition. Standard (basic) models provide only the components essential to restore functional ambulation; by contrast, deluxe models include electrical or mechanical enhancements and are treated as convenience items not covered under this policy.