Quad Cane

The Quad Cane has four rubber tipped prongs extending from an adjustable aluminum shaft. This cane provides more stability than a regular straight cane. Patients who need support and who can climb stairs use the Small Base Quad Cane. Patients who need more support and who are unable to climb stairs use the Large Base Quad Cane.

HCPCS Code:

E0105 - Quad cane

Category:

Inexpensive/Routinely Purchased

Common Diagnosis:

(check for current coding)

781.2 Gait Abnormality
340.0 Multiple Sclerosis (MS)
715.9 Osteoarthritis
428.0 Congestive Heart Failure
733.00 Osteoporosis
714.0 Rheumatoid Arthritis
343.9 Cerebral Palsy

Coverage Information

Requires a Detailed Written Order

The patient has impaired ambulation and there is a potential for ambulation.

• The patient 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; AND

• The patient 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

Documentation Requirements: in addition to the basic Medicare documentation (proof of delivery, AOB, detailed written order, etc.)

• The detailed written order form must contain the patient’s name, and a description of the item provided, physician signature and date, and the start date of the order if different than the physician signature date.