Are you a provider that bills for crutches or canes then this blog post is for you!

For single item:

Effective DOS 10/1/25 and thereafter the providers will only reimburse 1 cane or a crutch per patient/per day. Unless there is prior authorization with a justification given in advance.

For multiple crutches:

No multiple crutches will be reimbursed for the same date of services. This includes same type or different AND any type of billing different code combinations.

Additional code restrictions:

Codes E0110 and E0116 are only allowed to be billed with 1 unit if more than 1 unit is billed it will not be reimbursed.

Affected Plans:

*Child Health Plus (CHP)
• Medicaid Managed Care (MMC)
• Medicare Advantage
• Medicare PPO
• Personal Wellness Plan (PWP)/Health & Recovery (HARP)
• Essential Plan (EP)
• Managed Long Term Care Plan (MLTCP – Senior Health Partners)
• Medicaid Advantage Plus/MAP (CompleteCare)
• Qualified Health Plan (QH

Affected Codes:

• Healthfirst: crutches and cane reimbursement
• UHC Community Health of MA: 2 DSNP 2 plans important coverage update.
• NYS RX: adult vaccine reimbursement and Billing change
• Healthfirst: psychiatric evaluation reimbursement update
• Ambetter from Fidelis Care updated priorauthorization info