HCPCS code E0110 – Pair of forearm crutches

Key takeaways

HCPCS Code E0110 covers one pair of forearm (Lofstrand or elbow) crutches, so one billing unit equals two crutches.

Medicare Part B covers E0110 as durable medical equipment when the records document ambulatory dysfunction that meets the Canes and Crutches LCD criteria.

Every E0110 claim needs NU (purchase) or RR (rental), plus KX when the supplier attests that the LCD criteria are met.

A Standard Written Order replaced the Certificate of Medical Necessity in 2023, so no DME MAC asks for a CMN on crutches.

Claims management software such as Pabau checks each claim for missing details before it’s sent, so E0110 claims go out complete the first time.

HCPCS Code E0110: Official descriptor and device overview

HCPCS Code E0110 is part of the CMS HCPCS Level II code set. Its official descriptor reads: Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips. The unit of service is one pair.

Tips and handgrips are included in the base allowance. Billing replacement tips (A4637) or handgrips (A4636) alongside a new pair is unbundling.

A forearm crutch has a cuff that wraps around the user’s forearm instead of a pad that rests under the armpit. That design separates it from an axillary (underarm) crutch. Lofstrand crutch, elbow crutch, and Canadian crutch are all names for the same device.

E0110 belongs to the E0100–E0159 walking aids range of DME supplier HCPCS codes, alongside canes, walkers, and walker attachments.

The practical rule: if a patient is given two forearm crutches, bill E0110 once. If one crutch is provided (for example, a patient with single-arm use), bill E0111 once. Billing E0111 twice to represent a pair is a common coding error that triggers medical review.

Clinical indications: Who qualifies for E0110

E0110 fits a patient whose ambulatory dysfunction calls for the added forearm support of a Lofstrand crutch. The device must also be medically necessary for safe walking. Forearm crutches are commonly ordered after surgery, for long-bone fractures, and for neuromuscular conditions that affect gait.

Medical necessity is judged against the Canes and Crutches Local Coverage Determination (LCD L33733), which every DME MAC applies. Conditions that commonly support E0110 claims include the following.

• Lower extremity fractures that need non-weight-bearing or partial weight-bearing ambulation (for example, tibia, fibula, femur, or ankle)
• Post-surgical recovery following hip, knee, or foot/ankle procedures
• Neurological conditions affecting both legs (for example, multiple sclerosis, cerebral palsy, or incomplete spinal cord injury)
• Musculoskeletal impairments limiting normal gait (for example, severe osteoarthritis or Charcot-Marie-Tooth disease)
• Traumatic injuries requiring protected weight-bearing during recovery

Covered ICD-10-CM codes that support E0110

The ICD-10-CM code on the claim must reflect the patient’s specific diagnosis and, where possible, laterality. The table below lists commonly paired diagnosis codes. Check each one against the LCD before you dispense.

A diagnosis code that the LCD doesn’t support is one of the top denial triggers for E0110.

How to bill HCPCS Code E0110

Billing E0110 under Medicare Part B starts with DMEPOS supplier enrollment, and each claim goes to the DME MAC for the patient’s home address. DME billing software that checks each claim for missing details cuts manual errors on E0110 submissions. These are the steps for submitting a clean claim.

1. Confirm supplier enrollment. The DMEPOS supplier must hold a valid National Provider Identifier and be enrolled with the Medicare DME MAC that serves the beneficiary’s home address.
2. Obtain a Standard Written Order (SWO). The treating practitioner’s order lists the patient, order date, item, quantity, and the practitioner’s name or NPI, plus their signature. It must be on file before you submit the claim.
3. Skip the CMN. CMS retired Certificates of Medical Necessity (CMNs) and DME Information Forms for dates of service from January 1, 2023. The SWO replaced them, so no DME MAC requires a CMN for crutches today.
4. Document medical necessity in the patient record. The clinical notes must show ambulatory dysfunction that needs forearm crutches. They must also show why a less expensive option, such as an axillary crutch, won’t do.
5. Select the correct modifiers. Apply NU for a purchase or RR for a rental, plus KX when the supplier attests LCD criteria are met. See the modifier table below.
6. Bill one unit of E0110. One unit = one pair. Do not bill two units to represent two crutches.
7. Submit on CMS-1500 or 837P. Place of service is typically 12 (Home) or the beneficiary’s residence type. The supplier address on the claim must match the DMEPOS enrollment address.

Required modifiers for E0110 claims

Every E0110 claim sent to Medicare needs a modifier for the payment category, purchase or rental. When the supplier attests to the coverage criteria, KX goes on too. Missing modifiers are a primary cause of Medicare DME claim rejections.

Medicare coverage for HCPCS Code E0110

Medicare Part B covers forearm crutches as durable medical equipment under Section 1861(s)(6) of the Social Security Act. Coverage follows the Canes and Crutches LCD in the beneficiary’s jurisdiction. Two contractors run the four DME MAC jurisdictions: Noridian handles A and D, and CGS handles B and C.

The LCD criteria are the same across jurisdictions, but each MAC publishes its own billing guidance. DME claims also follow different rules from the medical billing workflows used for professional services, and those rules shape E0110 reimbursement.

Key Medicare coverage rules for E0110:

• Beneficiary cost-sharing: The patient pays 20% coinsurance after the Part B deductible is met. Participating suppliers accept Medicare assignment on every claim.
• Competitive Bidding Program: Forearm crutches may be included in the DMEPOS Competitive Bidding Program in certain geographic areas. Check whether the beneficiary’s ZIP code falls within a competitive bidding area (CBA) before billing. Non-contracted suppliers in a CBA cannot bill Medicare for covered items.
• No face-to-face rule: E0110 is not on the CMS Required Face-to-Face Encounter and Written Order Prior to Delivery List. The medical record must still show why the patient needs crutches.
• Reimbursement rates: Fee schedule amounts vary by year and by state. Use the CMS DMEPOS fee schedule for current payment amounts. Rates are not stated here because they change every year.

Documentation requirements for E0110

Documentation decides whether a denied E0110 claim can be won on appeal, and the record must exist before the item is dispensed. Good medical billing compliance means assembling this checklist before submitting any DME claim.

• Standard Written Order: Must include the patient’s name or Medicare ID, the order date, the item (forearm crutches, pair), and the quantity. It also names the treating practitioner by name or NPI and carries their signature. A verbal order lets you dispense, but the signed SWO must be on file before you bill.
• Clinical notes: The ordering practitioner’s chart notes must document the diagnosis and the functional limits behind the ambulatory dysfunction. They must also say why forearm crutches are needed over a less costly alternative.
• Length of need: The order should specify how long the crutches are expected to be required, especially if a rental is being billed.
• No Certificate of Medical Necessity (CMN): CMS retired CMNs for dates of service from January 1, 2023, and the SWO took their place. Don’t hold an E0110 claim waiting for one.
• Supplier delivery documentation: The supplier must keep proof of delivery, with the beneficiary’s or representative’s signature, the date, and the items delivered.
• Advance Beneficiary Notice (ABN): Required when the supplier believes Medicare may deny the claim. Without an ABN, the supplier cannot hold the beneficiary liable for payment.

E0110 vs adjacent crutch and mobility aid codes

The E0100–E0159 range covers canes, crutches, and walkers, and neighboring codes often differ by a word or two. The table below shows when to use E0110 instead of its closest neighbors. It includes the axillary crutch codes and the replacement codes for tips and handgrips.

The most important distinction for coders: if the device rests under the arm, it is an axillary crutch (E0112 through E0117). If it has a forearm cuff, it is a forearm crutch (E0110 or E0111). Mixing up the two is a routine source of claim rejections.

Check the current descriptor in the AAPC HCPCS code lookup when choosing between adjacent E-codes. The decision guide below maps both questions, cuff or underarm and pair or single, to the code that belongs on the claim.

Common denial reasons for HCPCS Code E0110

E0110 claims have predictable denial patterns. Good denial management in healthcare deals with them in the ordering and documentation workflow, well before an appeal.

• Missing or incomplete Standard Written Order: An SWO without the item, quantity, or practitioner signature fails review. Since CMS retired CMNs in 2023, the SWO is the order document reviewers check.
• Chart notes don’t support the need: Reviewers check the practitioner’s notes for the diagnosis and the walking limits. If the notes don’t explain why crutches are needed, the claim fails medical necessity.
• Non-covered ICD-10-CM diagnosis code: A diagnosis that doesn’t meet the LCD’s medical necessity criteria leads to denial. Cross-check the diagnosis against the LCD before dispensing.
• Incorrect unit billing: Billing two units of E0110 for one pair of crutches (each crutch separately) generates a duplicate denial. One unit of E0110 = one pair.
• Missing KX modifier: When a supplier attests that LCD coverage criteria are met, the KX modifier is required. Without it, the claim processes as unattested and is often denied as non-covered.
• Supplier not enrolled as DMEPOS supplier: A practice billing E0110 without DMEPOS supplier enrollment and accreditation gets a supplier eligibility denial. DMEPOS enrollment is separate from Medicare Part B professional enrollment.
• Competitive bidding program violation: Supplying crutches in a competitive bidding area without a Medicare contract for that area results in denial. A non-contracted supplier can still sell to a patient who pays out of pocket, but can’t bill Medicare.
• Billing replacement tips or handgrips with a new pair: The E0110 descriptor includes tips and handgrips. Billing A4637 tips or A4636 handgrips with a new E0110 pair on the same date of service is unbundling and triggers a denial.

How to appeal a denied E0110 claim

Medicare DME denials follow a five-level appeals process. When an E0110 claim was denied for missing paperwork, redetermination (Level 1) or reconsideration (Level 2) usually settles it.

1. Redetermination (Level 1): File with your DME MAC within 120 days of receiving the remittance notice. Send the original claim information plus the missing documentation, such as the signed SWO, clinical notes, or proof of delivery.
2. Reconsideration (Level 2): If the redetermination is upheld, file with a Qualified Independent Contractor (QIC) within 180 days. Include a written statement explaining why the documentation supports coverage and attach all medical records.
3. ALJ Hearing (Level 3): Available when the disputed amount meets the minimum threshold (updated annually). Request within 60 days of the QIC decision.
4. Medicare Appeals Council (Level 4) and Federal Court (Level 5): Reserved for cases that lost at the lower levels. The amount in controversy must also meet the threshold.

For a denial based on missing chart notes, ask the ordering practitioner for an addended note. It should document the visit date, the diagnosis, and the clinical reason for forearm crutches. Attach it at Level 1.

How claims management software prevents E0110 denials

The E0110 denials in this guide start before the claim is sent: a missing KX modifier, two units for one pair, or an unsigned order. Catching them by hand means rereading each claim line against the LCD and the order.

Pabau, the practice management platform we build, scrubs each claim for missing or invalid details before it reaches the clearinghouse. A claim with a problem is flagged Needs action, and the Fix button takes your biller straight to the field. In the US, eligibility checks run through Claim.MD, so coverage questions get answered before the crutches are dispensed.

Once the DME MAC pays, electronic remittance advice (ERA) files settle against each invoice. An E0110 claim that’s still unpaid stands out on the claims dashboard, well inside the 120-day redetermination window.

Send E0110 claims out right the first time

Pabau checks each claim for missing or invalid details before submission. It then tracks the claim to payment, so crutch claims stop coming back for paperwork.

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Conclusion

Most E0110 problems come down to paperwork: a second unit, a missing KX, or an order that doesn’t match the claim. The clinical case for forearm crutches is usually the easy part.

So build the unit rule, the modifier pair, and the SWO check into your billing template, and appeals become rare. The setup takes a few minutes per code family and pays back on the first denial your team never has to work.

Book a demo to see how Pabau checks each DME claim for missing details before your team submits it.

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