HCPCS E0118: Crutch substitute, lower leg platform, each

Learn how to properly use and bill for HCPCS code E0118 with our short guide.

## **What is HCPCS code E0118?** HCPCS code E0118, which has a code description of: "Crutch substitute, lower leg platform, with or without wheels, each," is a classification within the Healthcare Common Procedure Coding System (HCPCS) used for Durable Medical Equipment (DME). This code maintained by the Centers for Medicare and Medicaid Services (CMS), falls under the category of Walking Aids and Attachments within Durable Medical Equipment. This code is typically used for devices such as a knee scooter or knee walker (with wheels) or a type of hands-free crutch (like a lower leg platform that straps to the leg). The device serves as an alternative to traditional crutches for patients who have difficulty bearing weight on one leg due to injury or surgery, and may have difficulty using standard crutches. Medicare contractors have historically indicated E0118 is generally not covered as “reasonable and necessary”; approvals are uncommon. Document clinical need in the record, but expect denial under Medicare absent specific MAC guidance.

## **HCPCS code E0118 documentation requirements** For Medicare, the Canes and Crutches Local Coverage Determination (LCD L33733) establishes medical-necessity criteria for canes and crutches (E0100–E0116); E0118 (crutch substitute) is addressed in the related policy article (A52459) for coding, not as a covered item under that LCD’s criteria. Always verify the current MAC guidance. Consult the relevant resources to your situation for complete information. Key documentation elements generally include: ### **Prescribing practitioner's order** A Standard Written Order (SWO) from the treating physician or other qualified healthcare professional is required. ### **Medical necessity** Documentation in the patient's medical record must support the need for the device, typically demonstrating: - The patient has a functional mobility deficit that significantly impairs their ability to participate in mobility-related activities of daily living (MRADLs) in the home. - The patient has a reasonably determined heightened risk of serious harm when they try to perform any of the MRADLs. - The patient has difficulty using standard crutches, or standard crutches do not meet their medical needs. This specific reason must be documented. These are general guidelines for documentation, but remember, E0118 is generally not covered. ### **Diagnosis** The patient's diagnosis (ICD-10 code) must support the medical necessity for a crutch substitute. However, this is a general billing principle, not a requirement from any specific CMS article/LCD, since E0118 is generally noncovered. ### **Purchase vs. rental** The documentation and claim should indicate whether the device is being purchased (often requiring a NU modifier for new equipment) or rented (often requiring an RR modifier).

## **Billing requirements for HCPCS code E0118** To bill for HCPCS code E0118, the following requirements must be considered: - **Durable Medical Equipment**: E0118 is billed as DME. Providers must meet all DME supplier standards for their claims to be processed. - **"Each" Unit**: The code description specifies "each," meaning it is for a single device (e.g., one knee scooter). - **Medicare Coverage Alert (Important Note)**: For Medicare beneficiaries, it is crucial to check the specific Durable Medical Equipment Medicare Administrative Contractor (DME MAC) policies. Some DME MACs, in the past, have issued statements (like the now-retired Noridian policy) noting insufficient published clinical literature to establish medical necessity for these products in the Medicare population, meaning coverage may be denied or determined on a case-by-case basis. Issue an Advance Beneficiary Notice of Non-coverage (ABN) to the patient because Medicare does not cover this code. Do not use E1399 (miscellaneous DME) for canes or crutches with special features. E0118 specifically describes a crutch substitute: either a device strapped to the lower leg with a platform or a wheeled device with a platform propelled by the sound limb. Some commercial plans explicitly state knee scooters are not covered as crutch substitutes, even when other standard ambulatory aids are covered—policies vary, so check the member’s plan documents.

## **Other relevant codes** - **E0110**: Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips - **E0117**: Articulating crutch with two crutch legs connected by a bar between them (underarm) - **E0114**: Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips - **E0143**: Folding wheeled walker, adjustable or fixed height - **E0147**: Walker, heavy duty, multiple braking system, variable wheel resistance - **E0155**: Wheel attachment, rigid pick-up walker, per pair

Frequently asked questions

E0118 is generally noncovered by Medicare. Coverage is typically denied for E0118 as not reasonable and necessary; approvals are exceptional and policy-dependent.

The modifier NU (New equipment) is typically used for the purchase of DME items. The RR modifier (Rental) is used for rental claims.

The primary reason is a mobility limitation that significantly impairs the patient's ability to move within their home and is necessary because the patient cannot safely use or has documented difficulty using a standard crutch.