Is E0116 covered by Medicare?

Coverage varies by code, payer, and clinical context. Cross-check the current Medicare Local Coverage Determination (LCD) for the adjudicating Medicare Administrative Contractor (MAC), and any commercial payer policy for non-Medicare patients. Many HCPCS Level II codes (especially DME and certain drugs) require prior authorization.

What documentation is required for E0116?

Documentation must support medical necessity per the payer LCD or commercial-payer policy. For DME codes: written order, face-to-face encounter where required, beneficiary education. For drug codes: NDC, dose administered, units, route, site, wastage if applicable. For ambulance: origin, destination, miles, medical necessity. For supplies: linked diagnosis and medical necessity.

What are common denial reasons for E0116?

The most common denial categories are CO-16 (information missing or incorrect), CO-50 (medical necessity), and CO-151 (benefit maximum reached, often for DME rental cycles). Specific denial behavior varies by payer and plan.

Who can I get help from on E0116 billing?

For specialty-specific coding questions, AAPC- and AHIMA-credentialed coders on the Medonix team handle production billing for U.S. healthcare practices including HCPCS Level II claims (drugs, DME, ambulance, Medicare-specific procedures). Book a discovery call at /audit/ to talk through your specialty and payer mix.

HCPCS Level II · Durable medical equipment (DME)

E0116: Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each

Name: Medonix MSO
Address: 300 Delaware Ave Suite 210, Wilmington, DE, 19801, US
Telephone: +1-302-520-5413
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E0116 is the HCPCS Level II code for Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each. Section E, Durable medical equipment (DME). Section-level billing guidance applies.

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E0116Crutch underarm each no wood

Section: ECategory: Durable medical equipment (DME)Billable

About this code

Crutch underarm each no wood.

E0116 is a HCPCS Level II code in section E (Durable medical equipment (DME)). The full official descriptor is: Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each.

E-codes cover Durable Medical Equipment (DME). Document the underlying diagnosis requiring the equipment, the equipment specifications (make, model, serial number where applicable), and whether the encounter is rental (RR modifier), purchase (NU), or maintenance.

Payer-specific coverage rules vary. Always cross-check against the current Medicare Local Coverage Determination (LCD) for the adjudicating Medicare Administrative Contractor (MAC) or the commercial-payer policy.

Billing context

What practitioners watch for on E0116.

Section-level billing guidance for durable medical equipment (dme). Code-specific notes ship as the dataset matures.

Documentation

Common denial categories

CO-16: Information missing or incorrect on the claim or supporting documentation. Add documentation specificity (NDC for drugs, serial number for DME, mileage for transport) and resubmit.
CO-50: Service not deemed medically necessary. Confirm the diagnosis-procedure relationship matches the payer LCD/NCD; attach clinical justification and resubmit.
CO-151: Payer benefit maximum reached for this period (often DME rental cycles). Verify benefit history; for DME rental-to-purchase cycles confirm month count and switch billing to purchase code where applicable.

Coverage signal

DME coverage requires written order, face-to-face encounter for many items (CPAP, hospital beds), and specific medical-necessity documentation per Medicare DME LCD. Rental-to-purchase rules apply to capped-rental items.

Common specialties

Pulmonology · Family Medicine · Internal Medicine · Sleep Medicine

Companion codes

Codes commonly billed alongside E0116 based on Medonix client production data and CMS coding guidance.

2 codes

E0601CPAP deviceHCPCS
E0260Hospital bed, semi-electric, with mattressHCPCS

CPT is a registered trademark of the American Medical Association. Codes shown for educational reference only.

Related codes

Other codes in section E.

Search all codes

Sources

Where this entry comes from.

NLM Clinical Tables Search Service: the official U.S. National Library of Medicine API for HCPCS Level II lookup.
CMS HCPCS Quarterly Update: the authoritative HCPCS Level II release with annual major updates each January.
CMS Medicare Coverage Database: Local Coverage Determinations and National Coverage Determinations for payer-specific rules.

Frequently asked

About HCPCS code E0116.

E0116 is the HCPCS Level II code for Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each. It belongs to section E (Durable medical equipment (DME)). Document the supply, drug, or service per the code descriptor and pair with the diagnosis (ICD-10) supporting medical necessity.

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