E0261 — Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for items addressed in this policy.
- For DMEPOS base items that require WOPD, the supplier must have received a signed WOPD prior to delivery of the item.
- For DMEPOS base items with separately billed associated options/accessories/supplies, the WOPD must list the base item (and may list accessories) prior to delivery and separate billing of those items.
- Suppliers are required to maintain proof of delivery (POD) documentation and make it available to the Medicare contractor upon request.
Key Coverage Criteria
- An item is covered if it is an eligible Medicare benefit, is reasonable and necessary for diagnosis or treatment (meets SSA §1862(a)(1)(A)), and satisfies all other Medicare statutory and regulatory requirements.
- A fixed-height hospital bed (E0250, E0251, E0290, E0291, E0328) is covered when the beneficiary has a medical condition requiring positioning of the body in ways not feasible with an ordinary bed.
- A fixed-height hospital bed is covered when the beneficiary requires head-of-bed elevation >30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or aspiration risk.
- A fixed-height hospital bed is covered when the beneficiary requires specific body positioning to alleviate pain that cannot be achieved with an ordinary bed.
- A fixed-height hospital bed is covered when the beneficiary requires traction equipment that can only be attached to a hospital bed.
- A variable-height hospital bed (E0255, E0256, E0292, E0293) is covered if the beneficiary meets any fixed-bed criterion and requires a bed height different from a fixed-height bed to permit transfers to a chair, wheelchair, or standing position.
6 Active Policies
L33820 — Hospital Beds And Accessories
J19
DME101.001 — Hospital Beds and Related Equipment
UHC-POL-beds-mattresses — Beds and Mattresses
ANTHEM-CG-DME-15 — CG-DME-15 Hospital Beds and Accessories
UMR-POL-UMR-beds-mattresses — Beds and Mattresses
Related Codes
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