E0276 — Bed pan, fracture, metal or plastic
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 DMEPOS base items requiring a Written Order Prior to Delivery (WOPD), the signed SWO/WOPD must be received before delivery or the claim will be denied.
- For DMEPOS base items that require a WOPD, the WOPD must list the base item and may list separately billed associated options, accessories, and supplies; separately billed associated items without a completed signed WOPD of the base item will be denied.
- Claims must follow CMS HCPCS coding guidelines, LCDs, LCD-related Policy Articles, and DME MAC articles; claims not meeting coding guidelines shall be denied as not reasonable and necessary/incorrectly coded.
- Proof of delivery (POD) documentation is required to be maintained by the supplier and must be made available to the Medicare contractor upon request; services without appropriate POD shall be denied.
Key Coverage Criteria
- Bed pans (HCPCS E0275, E0276) are covered for beneficiaries who are bed-confined in accordance with NCD 280.1.
- Items must meet Medicare coverage rules: be within a defined Medicare benefit category, be reasonable and necessary for diagnosis/treatment or to improve function of a malformed body member, and meet all other Medicare statutory and regulatory requirements.
- Coverage of a dehumidifier every four years when medically necessary for HCSC members residing in Arkansas per § 23-79-1502 (relating to craniofacial anomaly corrective surgery).
- Coverage of specific durable medical equipment items as specified in the appropriate item-level Medical Policy and member contract benefits.
- Equipment serves a medical purpose.
- Equipment is not generally useful in the absence of illness, injury, or disease.
6 Active Policies
L36267 — Bowel Management Devices
J19
BCBSIL-DME101.000 — Durable Medical Equipment (DME) Reference List
BCBSMT-DME101.000 — Durable Medical Equipment (DME) Reference List
BCBSNM-DME101.000 — Durable Medical Equipment (DME) Reference List
BCBSOK-DME101.000 — Durable Medical Equipment (DME) Reference List
Related Codes
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