Does E0294 require prior authorization?

No, E0294 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E0294` — Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.

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.

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

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