HCPCS code E0116 – Non-wood underarm crutch

Key takeaways

HCPCS Code E0116 covers non-wood (aluminum, titanium, composite) underarm crutches, adjustable or fixed, billed per crutch.

E0114 covers that same non-wood underarm crutch dispensed as a pair, so the unit dispensed decides the code.

Medicare coverage requires a documented mobility limitation under LCD L33733 and a valid written order from the treating physician.

E0116 uses modifier NU for new purchase or RR for rental, and two crutches means two units on the claim.

Practice management software like Pabau keeps the written order, the delivery proof, and the invoice on one patient record.

HCPCS Code E0116: Official descriptor and code components

HCPCS Code E0116 describes a crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each.

According to the Centers for Medicare and Medicaid Services (CMS), the code sits in the HCPCS Level II E-series for durable medical equipment. The DMEPOS Pricing, Data Analysis and Coding (PDAC) contractor publishes the product classification decisions that say which specific products bill under it.

Breaking the descriptor into its components removes most coding errors before they reach a claim. Each part below is a check that error-checking claims management should make before the line is submitted.

What E0116 covers and what it excludes

E0116 covers any underarm crutch made from a material other than wood, adjustable or fixed, dispensed as a complete unit with pad, tip, and handgrip. Aluminum is the most common material billed under this code, though titanium and composite-frame crutches qualify equally.

The code does not cover replacement accessories billed after the initial dispensing. It also excludes crutches with a different anatomical placement, a different material, or a different billing unit.

• Included: Aluminum, titanium, or composite underarm crutches, adjustable or fixed, including shock-absorbing tip models
• Excluded, different placement: Forearm crutches, which bill as E0110 for a pair or E0111 each
• Excluded, different material: Wood underarm crutches, which bill as E0112 for a pair or E0113 each
• Excluded, different mechanism: Articulating, spring-assisted underarm crutches, which bill as E0117 each
• Excluded, different unit: A non-wood underarm pair, which has its own pair code, E0114
• Excluded, a crutch substitute: The lower leg platform device (E0118), which LCD L33733 lists as non-covered by Medicare
• Excluded, separate HCPCS codes: Replacement axillary pads (A4635), replacement tips (A4636), and replacement handgrips (A4637)
• Unit billing rule: Each crutch is one unit, so a patient receiving both left and right crutches needs two units

E0116 vs. related crutch HCPCS codes

The crutch E-code family is small but frequently confused. Material and anatomical placement narrow the choice, and the number dispensed settles it. E0110 through E0118 is the whole family, and the same descriptor-first check works across every HCPCS code reference in the E-series.

The axis that selects the code is the number dispensed, not the crutch type. E0114 and E0116 describe the same non-wood underarm crutch. E0114 covers the pair, while E0116 covers a single crutch, so a bilateral dispense billed under E0116 needs two units.

Switching a patient from a wood pair to an aluminum pair changes both the code and the unit count. One line of E0112 becomes one line of E0114, or two lines of E0116.

Medicare coverage criteria under LCD L33733

LCD L33733 (Canes and Crutches) is the Local Coverage Determination governing Medicare medical necessity for E0116 claims. The LCD is maintained by the relevant Medicare Administrative Contractors (MACs). It sets the conditions under which Medicare reimburses a non-wood underarm crutch dispensed by a Medicare-enrolled DMEPOS supplier.

Coverage applies when all of the following criteria are met. Confirm each one appears in the clinical record before the order is written, not after the crutch has been dispensed.

• The patient has a mobility limitation that significantly impairs ambulation and cannot be adequately remedied by a cane
• A crutch is the clinically appropriate assistive device for the patient’s condition
• The treating physician has ordered the crutch through a valid written order
• The DMEPOS supplier dispensing the crutch is enrolled in the Medicare DMEPOS program

LCD L33733 also specifies non-covered indications. Crutches dispensed for convenience, cosmetic reasons, or maintenance-only situations without an active mobility limitation are not reimbursable under Medicare. Documentation that fails to tie the crutch to an active mobility limitation is the leading denial trigger for E0116 claims.

E0116 documentation requirements

Documentation for E0116 must satisfy both the DMEPOS supplier’s delivery requirements and the medical necessity standards in LCD L33733. Missing a single element at the time of dispensing can produce a denial that is difficult to overturn on appeal.

Keep the following on file before the claim is submitted.

• Written order (prescription): Must be obtained before delivery; verbal orders must be followed by a written order within 7 days in most MAC jurisdictions
• Detailed written order (DWO): LCD L33733 requires the item description, quantity, and treating physician signature and date
• Face-to-face encounter notes: Clinical notes documenting the mobility limitation, the diagnosis, and the medical necessity of a crutch
• Delivery documentation: Proof of delivery signed by the patient or authorized representative, confirming the specific item dispensed
• Supplier delivery records: Item description, quantity, and serial or lot number where applicable

An incomplete or missing written order is the top denial trigger for E0116 claims. Suppliers that take a verbal order and deliver before the written order arrives face automatic denial under most MAC policies. Records supporting the medical necessity decision also have to be retained for your MAC’s stated retention period.

Modifiers used with HCPCS Code E0116

E0116 is typically a purchase item for Medicare billing, not a capped rental item. That distinction drives modifier selection. Verify the applicable modifier against current MAC billing guidelines before submission, as modifier requirements are payer-specific.

For standard bilateral dispensing, submit two claim lines, each carrying E0116 with modifier NU. Using RR on a purchased item triggers a rental payment conversion, which underpays the supplier and leaves a reconciliation problem behind. Capture the modifier at the point of dispensing rather than reconstructing it at billing.

2026 Medicare fee schedule for E0116

The 2026 Medicare DMEPOS fee schedule for E0116 varies by jurisdiction and competitive bidding area (CBA). CMS publishes annual DMEPOS fee schedule files rather than one national allowed amount. Rates differ between competitive bidding areas and the rest of the country, so a figure quoted without its jurisdiction is not usable.

To find the allowed amount for your zip code or CBA, start from the CMS DMEPOS fee schedule page. It carries the quarterly fee schedule files and the jurisdiction lists. Key pricing context for 2026:

• Competitive bidding areas: In designated CBAs, E0116 is paid under DMEPOS Competitive Bidding Program pricing, which usually sits below the non-CBA fee schedule amount
• Non-competitive bidding areas: Rates follow the national DMEPOS fee schedule, which CMS updates annually and publishes in the DMEPOS pricing files
• Purchase vs. rental rates: Purchase rates (NU) and rental rates (RR, KH, KI) are calculated separately, so confirm both if you offer both
• Medicare Part B coinsurance: The beneficiary pays 20% after the deductible, and supplemental insurance may cover the remainder

After payment, reconcile the allowed amount against the rate you expected for that jurisdiction. Catching an underpayment during the remittance cycle is far cheaper than finding it in an annual revenue review.

How to bill E0116: Step-by-step claim submission

E0116 Medicare billing follows the standard DMEPOS claim workflow with a few crutch-specific requirements. Each step below corresponds to a documentation checkpoint that, if missed, produces a preventable denial.

1. Confirm the device is non-wood: Verify the crutch dispensed is aluminum, titanium, or composite. If it is wood, use E0112 for a pair or E0113 for a single crutch.
2. Confirm the unit dispensed: A single crutch is E0116. A pair is either one unit of E0114 or two units of E0116, depending on your MAC’s billing instructions.
3. Verify LCD L33733 criteria are met: Confirm the clinical record documents a mobility limitation that significantly impairs ambulation. Confirm too that a crutch rather than a cane is appropriate.
4. Obtain the written order before delivery: The order must precede dispensing. Note the order date on your delivery documentation, because a post-delivery order date is an automatic denial.
5. Select the correct modifier: NU for new purchase is standard. Use RR with KH for a first-month rental. Never mix purchase and rental modifiers on the same claim.
6. Attach a supporting diagnosis code: Include an ICD-10-CM code reflecting the mobility limitation, such as a fracture, a neurological condition, or a post-surgical status.
7. Retain delivery documentation: Keep the signed proof of delivery with the item description, quantity, and delivery date. This is the first document requested on post-payment review.

For clean DMEPOS claims, work through submitting a clean claim before each submission cycle. An error caught before submission costs a fraction of what an appeal costs in staff time.

Common E0116 denial reasons and how to avoid them

E0116 denials cluster around six predictable failure points. Each one has a prevention measure that can sit inside the supplier’s intake and billing workflow, well before the claim is submitted.

Tracking denial patterns by reason code after each remittance cycle surfaces systemic problems faster than reviewing denials one at a time. A run of the same code across a month usually traces back to one step in your intake process.

Prior authorization requirements for E0116

E0116 is not on the CMS prior authorization list for DMEPOS items as of 2026. Crutches sit outside the required PA categories that cover power mobility devices and certain other DME. CMS updates that list periodically, so check the current version before dispensing.

Prior authorization requirements vary widely among non-Medicare payers. Confirm coverage and any PA requirement before dispensing, because a hold placed after delivery is hard to unwind.

• Medicare: No prior authorization required for E0116 as of 2026; verify against the current CMS PA list
• Commercial insurance: PA requirements vary by payer, so check each plan’s DME authorization policy before dispensing
• Medicaid: Most state Medicaid programs require PA for DME items including crutches, and requirements differ by state
• MAC pre-claim review: Some MACs run pre-claim review initiatives for DMEPOS items; confirm whether E0116 is in scope in your jurisdiction

How claims management software keeps E0116 documentation together

Most DMEPOS suppliers keep the written order in one system, the proof of delivery in another, and the invoice in a third. When a MAC asks for the file three months later, someone rebuilds it by hand from email and scanned paper.

Practice management software like Pabau holds all three against the same patient record. The order date, the delivery confirmation, and the invoice line carrying E0116 sit on one timeline. Checking that the order predates delivery then takes seconds rather than an afternoon.

Remittance data lands in the same place. When a jurisdiction pays below your expected rate for a unit of E0116, the shortfall shows against the claim itself. Nobody has to find it in a spreadsheet at quarter end.

Keep every E0116 document on one record

Pabau holds the written order, the proof of delivery, the invoice and the remittance against one patient record. A DMEPOS audit request then takes minutes to answer instead of an afternoon.

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Conclusion

E0116 rewards suppliers who check the physical device before they open the claim. Material decides whether you are in the wood family or the non-wood one. The number dispensed decides whether you bill E0114 or two units of E0116.

The written order is the part worth protecting hardest. Coverage arguments can be won on appeal with better clinical notes, but an order dated after delivery usually cannot be repaired at all.

Build both checks into intake and E0116 becomes a routine line rather than a recurring appeal. Book a demo to see how Pabau keeps orders, delivery proof, and remittance on one patient record.

Continue your research

Dispensing two crutches at once? HCPCS Code E0114: Non-wood underarm crutches covers the pair code that replaces two units of E0116.

Not sure whether the device counts as wood? HCPCS Code E0112: Wooden underarm crutches billing guide shows how material decides which crutch code you bill.

Patient sent home on forearm crutches instead? HCPCS Code E0111: Forearm crutch billing and coverage walks through the coverage rules for that crutch family.

Replacing a worn underarm pad? HCPCS Code A4635: Underarm pad, crutch, replacement explains when an accessory bills separately from the crutch.

Underarm crutches not appropriate for this patient? HCPCS Code E0118: Crutch substitute lower leg platform covers the substitute device and the notes it needs.

Frequently asked questions