Summary & Overview
HCPCS E0116: Underarm Crutch, Non‑Wood, Adjustable or Fixed
HCPCS Level II code E0116 denotes a non‑wood underarm crutch (adjustable or fixed) with pad, tip, and handgrip, with or without a shock absorber. As a widely used durable medical equipment (DME) item, this crutch supports ambulation across post‑operative, injury recovery, and disability care pathways. Nationally, correct coding of E0116 affects DME coverage determinations, claims processing, and beneficiary access to appropriate mobility aids.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses typical coverage patterns, documentation expectations, and where E0116 fits within DME benefit structures for commercial and federal payers. Readers will find benchmarks on utilization and reimbursement trends (when available), summaries of payer policy themes, and clinical context for when an underarm crutch is indicated versus alternative mobility devices.
This publication is intended to inform billing staff, DME suppliers, and policy analysts about coding characteristics, common coverage considerations, and operational implications of E0116 at a national level. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code E0116 describes an underarm crutch (non-wood), adjustable or fixed, with pad, tip, and handgrip, with or without shock absorber, each. This item is an assistive mobility device intended to support ambulation for patients with lower-extremity injury, disability, or post‑operative limitations.
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Service type: Durable Medical Equipment (DME) — mobility aid
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Typical site of service: Outpatient clinics, durable medical equipment suppliers, rehabilitation centers, and patient homes
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to an outpatient orthopedics clinic after sustaining a nondisplaced tibial plateau fracture while ambulating at home. The treating orthopedic surgeon determines the patient can be managed nonoperatively with protected weight bearing and prescribes underarm crutches. Durable medical equipment staff sources a pair of adjustable, nonwood underarm crutches with pads, tips, and handgrips. The clinical workflow: the provider documents the fracture diagnosis and medical necessity for ambulation assistance, writes an order for crutches specifying features (adjustable height, underarm pads, handgrips), the DME supplier verifies payer coverage and collects necessary documentation, supplies the device (one each) and provides brief patient instruction on height adjustment, safe ambulation, and fall precautions. Follow-up during clinic visits includes assessment of mobility, skin integrity under the pad, and continuation or discontinuation of crutch use based on healing progress and transition to cane or normal ambulation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
52 | Reduced services | When crutch supply is partial or components are missing relative to the full billed itemized description |
53 |