Table of Contents
Estimated reading time: 18 minutes
Key Takeaways
- Assistive device workers comp reimbursement usually covers medically necessary crutches, walkers, wheelchairs, and braces when properly prescribed, documented, and authorized.
- Rules vary by state and insurer, but strong documentation and proper HCPCS/L-coding are the fastest path to approval.
- Durable medical equipment approval WC follows a predictable workflow: physician order, vendor invoice, adjuster review, possible utilization review, and written authorization or denial with appeal rights.
- Mileage for medical appointments is commonly reimbursed when you submit a dated mileage log and appointment proof.
- Most denials are avoidable: missing physician order, inadequate objective findings, miscoded invoices, or skipping pre-authorization where required.
Quick answer / TL;DR
- Yes — crutches, walkers, wheelchairs and braces are generally reimbursable when medically necessary and authorized as part of assistive device workers comp reimbursement, consistent with the medical necessity standard and insurer policies tied to workers’ comp benefits (medical expense coverage in workers’ compensation; DME in workers’ comp).
- Typical requirements: treating physician order, objective findings, HCPCS/CPT code, vendor invoice, and pre-authorization where required — meeting these elements greatly reduces processing time (what can be reimbursed; DME approval workflow).
- Mileage for travel to medical appointments is typically reimbursable with a dated mileage log and appointment documentation (mileage reimbursement guidance).
- Common denials: missing physician order, inadequate documentation, coding errors, no prior authorisation — fix by supplying detailed necessity and correct codes (medical necessity; documentation and coding).
- Keywords covered: assistive device workers comp reimbursement; crutches compensation workers comp; workers comp pay for walker or wheelchair; medical brace work injury claim; durable medical equipment approval WC.
Introduction
This guide explains assistive device workers comp reimbursement — whether mileage, crutches, walkers, wheelchairs or medical braces are covered, what documentation is required, and common reasons claims are denied. In most states, devices are reimbursed when they’re medically necessary and authorized; mileage to medical appointments is commonly reimbursed as well. To avoid delays, remember: Rules vary by state, but common requirements include a treating physician’s order, objective findings, correct HCPCS/CPT codes, and pre-authorization or utilization review when required.
Because durable medical equipment approval WC is governed by both statutes and insurer medical policies, it helps to follow a clear, step-by-step submission process and use proper coding. The medical necessity standard is central to coverage, so a specific physician order and objective findings are key (medical expense coverage in workers’ compensation; DME in workers’ comp; what can be reimbursed from a workers’ comp claim).
Key definitions
Assistive device: “Any equipment that helps an injured worker perform activities or mobility (e.g., crutches, walker, wheelchair, brace).” In practice, assistive device workers comp reimbursement hinges on whether the device restores safe function during recovery and is medically necessary for the work injury (definition & coverage concepts).
Durable Medical Equipment (DME): “Equipment intended for repeated use, medically necessary, appropriate for home use; common examples include crutches, walkers, wheelchairs and braces.” Include a clear request for durable medical equipment approval WC when required (DME use in workers’ comp).
Rental vs purchase: “Rental is appropriate for temporary needs; purchase is justified for long-term or permanent needs. Explain typical indicators: anticipated duration > X months (state dependent) supports purchase.” Many medical policies use expected duration to guide rental vs. purchase decisions (rental vs. purchase considerations; insurer policy examples).
Crutches: “Hand-held mobility aids used for temporary non-weight-bearing or partial weight-bearing ambulation.” For crutches compensation workers comp decisions, orders should state the non-weight-bearing status and duration (coverage of medical items).
Walker: “Frame-based mobility support for persons with longer-term or more severe gait impairment.” This often follows a mobility evaluation; documentation supports workers comp pay for walker or wheelchair (DME considerations).
Wheelchair: “Manual or powered seating and mobility devices for severe or permanent mobility loss.” Power devices typically require higher-level review and home/worksite access review (DME considerations).
Medical brace: “An orthotic device to support, immobilize, or protect an injured body part; includes off-the-shelf and custom options.” Clear objective findings are critical for a medical brace work injury claim (orthotic coverage concepts).
Reimbursement/approval in WC context: “Reimbursement = insurer pays vendor/provider once device is approved and billed under appropriate codes; approval often requires pre-authorization or utilization review.” This is the core path for durable medical equipment approval WC (approval workflow).
Legal & regulatory framework
Coverage and reimbursement rules for assistive devices are governed by state workers’ compensation statutes, fee schedules, insurer medical policies, and the medical necessity standard. In other words, even when a device is clinically sound, the claim still hinges on the statute, fee limits, and the carrier’s medical policies interpreting “necessity” in workers’ comp (what’s reimbursable; insurer DME practices; medical expense coverage).
Parties and roles
- Treating physician: provides the device order; documents medical necessity and objective findings (exam results, imaging, functional limits) (treating physician’s role).
- Claims adjuster: verifies the claim, reviews documentation, and requests utilization review when needed — frequently for higher-cost items (adjuster and UR roles).
- Utilization review/IME: assesses clinical appropriateness for costlier devices (e.g., powered wheelchairs, custom braces) (UR/IME in DME).
Durable medical equipment approval workflow
- Physician order: includes diagnosis, HCPCS/CPT code, duration estimate, and a functional limitation statement that explains why the device is needed.
- Vendor submission: vendor or provider submits an invoice with the HCPCS code and supporting clinical documentation to the adjuster.
- Insurer review: adjuster conducts initial review; if needed, sends to utilization review for medical necessity assessment.
- Decision: authorization issued or denial with a letter that cites reasons and appeal instructions. Authorization typically arrives 1–4 weeks after a complete submission, though timelines vary by state and insurer (workflow and timelines; reimbursement expectations).
New to the process? Our guide to how to file a workers’ comp claim in California explains required forms and timelines that affect DME requests, too.
Criteria for coverage and approval
To get DME reimbursed, submit a complete packet with the elements below; missing any is the most common denial reason.
- Treating physician’s order: must include patient name, diagnosis (ICD code), device name, HCPCS/CPT code, anticipated duration, and a one-sentence justification of medical necessity (e.g., “Non-weight-bearing status requiring crutches for ambulation for 6 weeks”). This is central to assistive device workers comp reimbursement and should be equally specific for a medical brace work injury claim (physician order content).
- Objective findings: exam results, imaging reports, functional tests (e.g., gait analysis, Timed Up and Go). Include the date, provider, and numeric scores if applicable (documentation basics; objective proof for DME).
- Justification for device: brief explanation of why alternatives (e.g., cane, non-braced activity) are insufficient, expected functional benefit, and impact on return-to-work. For braces, tie this to the medical brace work injury claim with clear functional limits (clinical justification).
- HCPCS/CPT code: include code and short description. Example: “Invoice must list HCPCS E0117 (axillary crutches) and unit cost.” (coding and descriptions)
- Vendor/provider invoice: list vendor name, NPI or credential, date of service, device description, unit price, and rental terms if applicable (invoice elements).
- Pre-authorization documentation: copy of authorization approval or proof of submission if required by the state/insurer for durable medical equipment approval WC (pre-auth practices).
- Mobility evaluation (walkers/wheelchairs): include home/worksite accessibility, ADL limitations, and therapist recommendations — critical for workers comp pay for walker or wheelchair (mobility needs; evaluation support).
- Mileage log (travel reimbursement): date, origin/destination, purpose, miles, odometer start/end, signature (mileage elements). See our detailed guide on workers’ comp mileage reimbursement in California.
If denied: Common corrective evidence includes a physician’s supplemental letter, functional test results, photos, prescription clarification, and IME reports. Use the denial letter’s reasons as a checklist to close documentation gaps (responding to denials; strengthening documentation). For a deeper dive into building the record, see our complete documentation checklist.
Device-specific guidance
crutches compensation workers comp
Lead: Crutches are routinely reimbursed for temporary mobility loss when ordered by the treating physician and supported by objective findings (coverage rules; DME processes).
Documentation checklist: physician order that includes HCPCS E0117 (axillary crutches), injury description, weight-bearing status (e.g., non-weight-bearing right lower extremity), expected duration, and vendor invoice.
Sample physician order (copy-ready):
“Patient requires axillary crutches (HCPCS E0117) for non-weight-bearing ambulation of the right lower extremity for approximately 6 weeks due to right ankle fracture (ICD-10 S82.###).”
Typical denials and fixes: No prescription → submit a signed physician order; vague need → add functional limitation note (“unable to bear weight x 6 weeks”); missing code → include E0117 and a pricing line item. If problems persist, review our guidance on appealing a denied benefit.
medical brace work injury claim
Lead: Braces — both off-the-shelf and custom — are covered when documentation shows they address a work-related impairment and alternatives are inadequate (coverage concepts; orthoses in workers’ comp).
Types: off-the-shelf (prefabricated) and custom-fabricated orthoses; examples include wrist splints, knee sleeves, and custom lumbar orthoses.
Documentation checklist: physician diagnosis and mechanism of injury; functional limitation; trial of conservative care (if required by policy); detailed brace type and L-code (e.g., L1832 knee orthosis); measurements for custom items; vendor invoice.
Sample physician note (copy-ready):
“Lumbar support brace (L0627) indicated for persistent lumbar instability after 8 weeks conservative care; patient reports pain limiting sit/stand >30 minutes, physically demanding job requires stabilization to return to modified duty.”
Typical denials and fixes: Vague order → add clinical findings and functional limitations; custom brace denied → add measurements, prior conservative care evidence, and therapist recommendation. If a dispute escalates, understanding the QME process can be pivotal.
workers comp pay for walker or wheelchair
Lead: Walkers and wheelchairs are approved when mobility evaluations document need; manual devices are easier to authorize than power chairs (mobility and ADL needs; DME approvals; rental vs. purchase factors).
Documentation checklist: therapist mobility evaluation; home/work accessibility survey; physician order with HCPCS code (e.g., E0143 walker; E0636 manual wheelchair; K0005 power wheelchair); expected duration; vendor invoice or rental agreement.
Rental vs purchase: rent for short-term needs; purchase when long-term/permanent need is documented. Power wheelchairs typically require evidence of inability to safely self-propel, seating needs, and environmental assessments.
Sample wording (copy-ready):
“Manual wheelchair (HCPCS E0636) required due to permanent lower extremity paralysis; mobility evaluation attached. Purchase requested given permanent need and home accessibility assessment.”
Typical denials and fixes: Missing mobility evaluation → obtain therapist assessment; power chair denied for lack of home accessibility proof → add home assessment and rehabilitation specialist recommendations.
durable medical equipment approval WC
Lead: Durable medical equipment approval WC generally requires a physician order, HCPCS code, vendor invoice, and may require utilization review for higher-cost items (approval steps; what is reimbursable).
- Workflow recap: physician order → vendor invoice submission → claims review → utilization review (if needed) → authorization or denial (with appeal steps).
- Timelines: authorization typically 1–4 weeks once the packet is complete; flag urgent needs (e.g., immediate mobility) with same-day physician letters and objective findings.
For a broad overview of benefits beyond DME, our guide to workers’ compensation benefits explains medical coverage, wage replacement, and more.
Mileage and travel
Lead: Mileage to medical appointments is usually reimbursed under workers’ comp with a dated mileage log and purpose of each trip (mileage rules).
Documentation: mileage log (date, origin, destination, purpose, miles, odometer); appointment documentation (date/time/purpose); claim line-item indicating travel. Typical per-mile rates range $0.50–$0.65, but they vary by state and policy. Copy-ready note: “Check state fee schedule or insurer policy for the per-mile rate and any caps.” If your travel is to mobility evaluations for walkers or wheelchairs, clearly connect the trip to the device request. If payment is denied, see how to respond in our resource on denied mileage reimbursement.
Billing, codes, and vendor/provider guidance
Bottom line: Accurate HCPCS/CPT coding and complete vendor invoices are critical — errors commonly trigger denials (coding tips and errors).
Common codes and short descriptions (hyperlinked to a validated reference):
- E0117 — axillary crutches (crutches)
- E0143 — walker, folding, wheeled (walker)
- E0636 — manual wheelchair
- K0005 — power (ultra-lightweight/performance) wheelchair
- L1832 — knee orthosis (brace)
- L3908 — wrist/hand orthosis
- L0627 — lumbar support
Submission steps for providers/vendors:
- Prepare invoice with vendor credentials (NPI, address, credentials), HCPCS code(s), device description, itemized cost, rental terms/dates.
- Submit to the claims adjuster with the physician order, objective findings, and any pre-authorization paperwork.
- For mileage, include a separate line-item and attach the mileage log and appointment proof; identify the travel as medical reimbursement.
- Expect payment amounts to follow state fee schedules; many reference CMS/Medicare methodologies. Always confirm your state’s DME fee schedule (billing considerations; reimbursable costs).
Not sure what else to include? Review our claim documentation requirements before submitting.
Common problems and how to avoid them
- Missing physician order → build a template and require a physician signature on every device requisition.
- Inadequate medical necessity → include objective findings and functional limits; add test scores or imaging summaries.
- Uncredentialed vendor → verify NPI and credentials before procurement.
- Coding errors → cross-check the HCPCS/L-codes across the physician order, invoice, and documentation.
- No pre-authorization → maintain a pre-auth checklist and submit before ordering higher-cost equipment.
Pre-authorization checklist (copy-ready):
- Physician order with diagnosis + HCPCS/L-code
- Objective findings and functional limitations
- Vendor invoice + credentials
- Mobility/accessibility evaluation (if applicable)
- Completed mileage log (if travel reimbursement requested)
- Proof of pre-authorization submission
These prevention steps align with insurer practices around DME and reduce delays (DME prevention tips). If your equipment request ties into work status, our primer on temporary vs. permanent disability can help you align documentation with restrictions.
Appeals and dispute resolution
- Read the denial letter: note the reason cited and the deadline for appeal.
- Gather supplemental evidence: a physician addendum clarifying necessity, therapist mobility evaluations, functional assessments, photos, vendor justification and cost comparison, or IME opinions.
- Submit first-level appeal: send to the adjuster with a cover letter referencing the denial date and attaching the new documentation.
- Escalate if needed: if internal appeal fails, follow your state process — utilization review reconsideration, an independent medical exam, or a state commission appeal/hearing.
Timelines: File first-level appeals within 14–30 days of denial; many carriers issue decisions within 30–60 days (check state rules). Consider counsel if the device cost is significant, denials repeat, or medical necessity remains disputed (appeal windows and documentation; appeal documentation). If you need structured guidance, read our step-by-step on appealing a denied workers’ comp benefit.
Real-world examples / mini case studies
Intro: Include three concise, realistic mini case studies showing common outcomes, with sample documentation the copywriter can paste into post.
Case study 1 — Approved crutches
Scenario: An assembly-line worker with a nondisplaced ankle fracture received crutches approved and paid.
Key document sample (copy-ready):
“Physician order: ‘Patient requires axillary crutches (HCPCS E0117) for non-weight-bearing ambulation of left lower extremity for 6 weeks due to left ankle fracture (ICD-10 S82.##). Signed Dr. X, Date.’”
Outcome: Claim approved after vendor invoice filed with HCPCS code; insurer paid vendor directly. This aligns with typical crutches compensation workers comp decisions (medical expense coverage).
Case study 2 — Denied brace, later approved on appeal
Scenario: Initial claim for knee brace denied for insufficient justification; subsequent appeal included physiatrist exam and functional scores leading to approval.
Appeal cover letter sample (copy-ready):
“To Claims: Attached additional exam findings including range-of-motion measurements and WOMAC score demonstrating persistent instability. Recommend L1832 knee orthosis. Signed Dr. Y.”
Outcome: Appeal approved; vendor paid upon resubmission. This tracks medical necessity standards for a medical brace work injury claim (necessity; brace coding and documentation).
Case study 3 — Wheelchair rental denied vs purchase approved
Scenario: Short-term manual wheelchair rental denied; after mobility evaluation and home accessibility survey, purchase of manual wheelchair approved.
Mobility evaluation excerpt (copy-ready):
“Therapist note: ‘Patient demonstrates absent plantarflexion reflex and cannot ambulate household distances. Manual wheelchair (E0636) recommended for community mobility. Home access feasible for wheelchair use.’”
Outcome: Purchase approved with E0636 and vendor invoice — consistent with rental vs. purchase standards when permanent need is documented (reimbursement scope; DME documentation).
State variation and where to look for rules
State rules and fee schedules vary; always check the applicable state workers’ comp commission and insurer medical policy before ordering DME. Many states reference Medicare methodologies and require either pre-authorization or utilization review for higher-cost items. Practical guidance from state bar associations and fee schedule bulletins also helps set expectations (state-by-state cautions; DME and policy variation; coverage fundamentals).
Need a refresher on core benefits and timelines that impact equipment approvals? See our guides to workers’ compensation benefits and to filing a claim in California, including deadlines that can affect DME requests.
Practical checklist / downloadable resource
What to Submit for DME Reimbursement
- Treating physician’s order (include ICD/diagnosis, HCPCS/CPT code, duration estimate, justification)
- Objective findings / exam and imaging reports
- HCPCS/CPT code (listed and explained)
- Vendor/provider invoice (with NPI, itemized cost, rental terms if applicable)
- Prior authorization or pre-auth submission confirmation
- Mobility/accessibility evaluation for walkers/wheelchairs
- Mileage log (dates, miles, purpose, odometer)
- Contact info for vendor and claims adjuster
When to Seek Help
- Claim denied for medical necessity
- Complex/custom DME needed (power wheelchair, custom orthosis)
- Conflicting medical opinions or repeated denials
- Need for IME, vocational rehab or attorney involvement
These checklists support assistive device workers comp reimbursement, durable medical equipment approval WC, crutches compensation workers comp, medical brace work injury claim, and workers comp pay for walker or wheelchair decisions. For broader context, review our resources on benefits, claim filing, and settlement charts.
Conclusion
Insurers reimburse assistive devices when the need is clear, the codes are correct, and the paperwork is complete. If an assistive device helps you safely function during recovery — and your physician documents objective findings and functional limits — you can usually expect approval after the adjuster and, if necessary, utilization review. When in doubt, submit a thorough packet and respond precisely to any denial reasons with supplemental evidence. Keep mileage logs for every trip, and tie every device request back to return-to-work function and safety. With the right documentation and a structured approach, most injured workers can obtain the crutches, walkers, wheelchairs, braces, and travel cost reimbursements they need to heal well and move forward.
Need help now? Get a free and instant case evaluation by Visionary Law Group. See if your case qualifies within 30-seconds at https://eval.visionarylawgroup.com/work-comp.
FAQ
Are crutches reimbursable under workers’ comp?
Yes, crutches compensation workers comp claims are typically approved when the treating physician orders them and documentation shows medical necessity with objective findings. Make sure your order includes HCPCS E0117, expected duration, and a vendor invoice (coverage and documentation; coding and approval).
Will workers’ comp pay for walker or wheelchair?
Yes — workers comp pay for walker or wheelchair requests are commonly approved when a therapist’s mobility evaluation documents the need and the order carries proper HCPCS coding and duration. Power chairs usually require additional review and home/worksite accessibility assessments (reimbursement criteria; DME requirements).
How do I file a medical brace work injury claim?
Submit a physician’s prescription with diagnosis, the appropriate L-code, objective findings, and a vendor invoice to your claims adjuster; follow pre-authorization rules if required. If denied, add measurements, conservative care history, and functional scores to support medical necessity (documentation standards; orthotic coding).
How long does durable medical equipment approval WC take?
Typically 1–4 weeks with complete documentation, though state and insurer timelines vary. Flag urgent needs with a same-day letter and objective findings (workflow and timing; reimbursement expectations).
Is mileage to medical appointments reimbursed?
Yes — submit a dated mileage log with appointment documentation; rates and caps are state-dependent. If the travel relates to mobility evaluations for walkers or wheelchairs, note that within the log to support assistive device workers comp reimbursement (mileage and travel guidance).
For more on filing and timelines (including DME), see our practical guides to claims, documentation, and appeals.
