Does A4635 require prior authorization?

No, A4635 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A4635?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A4635`, Underarm pad, crutch, replacement, each

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

For DMEPOS base items that require a Written Order Prior to Delivery (WOPD), the supplier must have a signed WOPD before delivery of the item.
A Standard Written Order (SWO) must be received by the supplier before a claim is submitted for the item.

When separately billed options/accessories/supplies accompany a base DMEPOS item that requires a WOPD, the WOPD must list the base item (and may list associated items) prior to delivery.

Claims must be coded in accordance with CMS HCPCS coding guidelines, relevant LCDs, LCD-related Policy Articles, and DME MAC articles; supporting medical records must document the medical necessity criteria.

Refer to the LCD-related Standard Documentation Requirements Article, LCD-related Policy Article, the Supplier Manual, and DME MAC web sites for additional documentation requirements and forms.

Key Coverage Criteria

An item is covered only if it is in a defined Medicare benefit category, is reasonable and necessary for diagnosis/treatment or to improve function of a malformed body member, and meets all other Medicare statutory and regulatory requirements.
Canes (E0100, E0105) and crutches (E0110, E0111, E0112, E0113, E0114, E0116) are covered if the beneficiary has a mobility limitation that significantly impairs participation in one or more mobility-related activities of daily living (MRADL) in the home.
A mobility limitation exists when it prevents accomplishing the MRADL entirely, places the beneficiary at a reasonably determined heightened risk of morbidity or mortality while attempting the MRADL, or prevents completion of the MRADL within a reasonable time frame.
The beneficiary must be able to safely use the cane or crutch.
The beneficiary's functional mobility deficit must be sufficiently resolved by use of a cane or crutch.
Canes, quad canes, and crutches are medically necessary if all of the following criteria are met: The member has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADL) in the home (toileting, feeding, dressing, grooming, and bathing); the member is able to safely use the cane or crutch; and the functional mobility deficit can be sufficiently resolved by use of a cane or crutch.

2 Active Policies

L33733, Canes and Crutches

AETNA-CPB-0505, Ambulatory Assist Devices: Walkers, Canes, and Crutches

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A4635, Underarm pad, crutch, replacement, each