E0118 - Crutch Substitute - JD DME
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:
DME LCD Reconsiderations
Fargo, ND 58108-6747
Please address your fax coversheet to the "DME LCD Reconsideration Administrator"
Last Updated Fri, 26 Oct 2018 13:48:23 +0000