Does E0117 require prior authorization?

No, E0117 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E0117` — Crutch, underarm, articulating, spring assisted, each

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For DMEPOS base items that require a Written Order Prior to Delivery (WOPD), the supplier must have a signed WOPD before delivery of the item.
A Standard Written Order (SWO) must be received by the supplier before a claim is submitted for the item.
When separately billed options/accessories/supplies accompany a base DMEPOS item that requires a WOPD, the WOPD must list the base item (and may list associated items) prior to delivery.
Suppliers must maintain proof of delivery (POD) documentation and make it available to the Medicare contractor upon request.

An item is covered only if it is in a defined Medicare benefit category, is reasonable and necessary for diagnosis/treatment or to improve function of a malformed body member, and meets all other Medicare statutory and regulatory requirements.
Canes (E0100, E0105) and crutches (E0110, E0111, E0112, E0113, E0114, E0116) are covered if the beneficiary has a mobility limitation that significantly impairs participation in one or more mobility-related activities of daily living (MRADL) in the home.
A mobility limitation exists when it prevents accomplishing the MRADL entirely, places the beneficiary at a reasonably determined heightened risk of morbidity or mortality while attempting the MRADL, or prevents completion of the MRADL within a reasonable time frame.
The beneficiary must be able to safely use the cane or crutch.
The beneficiary's functional mobility deficit must be sufficiently resolved by use of a cane or crutch.
Canes, quad canes, and crutches are medically necessary if all of the following criteria are met: The member has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADL) in the home (toileting, feeding, dressing, grooming, and bathing); the member is able to safely use the cane or crutch; and the functional mobility deficit can be sufficiently resolved by use of a cane or crutch.

L33733 — Canes and Crutches

J19

BCBSIL-DME101.000 — Durable Medical Equipment (DME) Reference List

AETNA-CPB-0505 — Ambulatory Assist Devices: Walkers, Canes, and Crutches

BCBSNM-DME101.000 — Durable Medical Equipment (DME) Reference List

BCBSOK-DME101.000 — Durable Medical Equipment (DME) Reference List

Ask Verity about documentation requirements, denial risks, or coverage in your state.