23 Miss. Code. R. 209-1.21

Current through October 31, 2024

Rule 23-209-1.21 - Crutches

A. Medicaid defines crutches as assistive devices used for support during ambulation.

1. Crutches may provide underarm or forearm support.

2. Crutches may be made of wood or metal, fixed or adjustable in height and must be supplied with tips.

B. Medicaid covers crutches for all beneficiaries when prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity.

1. Medicaid covers underarm crutches when the following criteria are met:

a) Post-op or post injury to reduce or alleviate weight bearing through the lower extremities.

b) Progression to ambulation without an assistive device.

2. Medicaid defines forearm crutches as crutches that decrease energy consumption during ambulation and provide increased support through the upper extremities.

a) Forearm crutches can be made of various materials, adjustable or fixed, and must be dispensed as a pair complete with handgrips.

b) Medicaid covers forearm crutches when the following criteria is met:

1) For those who will be long-term crutch users;

2) For use with beneficiaries whose balance does not require the base of support (BOS) provided by a walker; and

3) For beneficiaries who need the assistance provided by the crutch to increase their independence in the community. Beneficiaries may use a reciprocating, swing through, or swing to type of gait.

C. Medicaid covers customized crutches with prior authorization by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity.

D. Attachments to crutches are indicated when one (1) or both upper extremities are compromised due to surgical intervention, decreased range of motion, or contracture. The beneficiary may also need the attachment to provide a greater area of support.

E. Platform attachments are indicated when one (1) or both upper extremities have decreased range of motion at the elbow, shoulder, or wrist and allow the beneficiary to grasp and hold onto the crutch.

F. Tips, hand grips, adjustment features, and other accessory items not specifically listed as covered are inclusive in the rental or purchase of the crutches and Medicaid does not reimburse these as separate items.

23 Miss. Code. R. 209-1.21

42U.S.C. § 1395m; Miss. Code Ann. §§ 43-13-117(17), 43-13-121.

Amended 9/1/2018