E0118 - Crutch Substitute

Posted on May 4, 2017

This is a re-posting of an article originally posted on February 18, 2010. Coverage remains denied for the E0118.

Section 1862 of the Social Security Act requires that an item or service must be "reasonable and necessary" before payment may be made. A reasonable and necessary determination is largely based on a review of the published clinical literature that is relevant to the item under consideration. When there is no published policy for an item, contractors may still make individual determinations when reviewing claims.

The DME MACs have received questions concerning coverage of HCPCS code E0118:

E0118 - Crutch substitute, lower leg platform, with or without wheels, each

The DME MAC medical directors have reviewed information about the products billed using this code. The determination is that there is insufficient published clinical literature demonstrating safety and effectiveness in the Medicare population to establish the medical necessity for these products.

Medical literature supporting coverage of these items can be submitted to:

Method Instructions
Mail Noridian
DME LCD Reconsiderations
Box 6747
Fargo, ND 58108-6747
Fax 701-277-7888
Please address your fax coversheet to the "DME LCD Reconsideration Administrator"
Email dmeregdlcdreconsider@noridian.com

 

Last Updated Oct 26 , 2018