Is E0260 covered by Medicare?

Coverage varies by code, payer, and clinical context. Cross-check the current Medicare Local Coverage Determination (LCD) for the adjudicating Medicare Administrative Contractor (MAC), and any commercial payer policy for non-Medicare patients. Many HCPCS Level II codes (especially DME and certain drugs) require prior authorization.

What documentation is required for E0260?

Documentation must support medical necessity per the payer LCD or commercial-payer policy. For DME codes: written order, face-to-face encounter where required, beneficiary education. For drug codes: NDC, dose administered, units, route, site, wastage if applicable. For ambulance: origin, destination, miles, medical necessity. For supplies: linked diagnosis and medical necessity.

What are common denial reasons for E0260?

The most common denial categories are CO-16 (information missing or incorrect), CO-50 (medical necessity), and CO-151 (benefit maximum reached, often for DME rental cycles). Specific denial behavior varies by payer and plan.

Who can I get help from on E0260 billing?

For specialty-specific coding questions, AAPC- and AHIMA-credentialed coders on the Medonix team handle production billing for U.S. healthcare practices including HCPCS Level II claims (drugs, DME, ambulance, Medicare-specific procedures). Book a discovery call at /audit/ to talk through your specialty and payer mix.

HCPCS Level II · Durable medical equipment (DME)

E0260: Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress

Name: Medonix MSO
Address: 300 Delaware Ave Suite 210, Wilmington, DE, 19801, US
Telephone: +1-302-520-5413
Price range: $$

E0260 is the HCPCS Level II code for Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress. Section E, Durable medical equipment (DME). Code-specific billing context provided.

Search another code Talk to a credentialed coder

E0260Hosp bed semi-electr w/ matt

Section: ECategory: Durable medical equipment (DME)Billable

About this code

Hosp bed semi-electr w/ matt.

E0260 is a HCPCS Level II code in section E (Durable medical equipment (DME)). The full official descriptor is: Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress.

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress. Document the bed-confining condition requiring positioning (heart failure, severe respiratory disease, pressure ulcer prevention).

Payer-specific coverage rules vary. Always cross-check against the current Medicare Local Coverage Determination (LCD) for the adjudicating Medicare Administrative Contractor (MAC) or the commercial-payer policy.

Billing context

What practitioners watch for on E0260.

Code-specific billing guidance for E0260, written from production billing experience.

Documentation

Common denial categories

CO-16: Information missing or incorrect on the claim or supporting documentation. Add documentation specificity (NDC for drugs, serial number for DME, mileage for transport) and resubmit.
CO-50: Service not deemed medically necessary. Confirm the diagnosis-procedure relationship matches the payer LCD/NCD; attach clinical justification and resubmit.
CO-151: Payer benefit maximum reached for this period (often DME rental cycles). Verify benefit history; for DME rental-to-purchase cycles confirm month count and switch billing to purchase code where applicable.

Coverage signal

Hospital beds are capped-rental DME. Coverage requires written order, face-to-face encounter, and specific medical-necessity criteria per Medicare DME LCD.

Common specialties

Internal Medicine · Family Medicine · Hospice

Companion codes

Codes commonly billed alongside E0260 based on Medonix client production data and CMS coding guidance.

2 codes

E0601CPAP deviceHCPCS
E0260Hospital bed, semi-electric, with mattressHCPCS

CPT is a registered trademark of the American Medical Association. Codes shown for educational reference only.

Related codes

Other codes in section E.

Search all codes

Sources

Where this entry comes from.

NLM Clinical Tables Search Service: the official U.S. National Library of Medicine API for HCPCS Level II lookup.
CMS HCPCS Quarterly Update: the authoritative HCPCS Level II release with annual major updates each January.
CMS Medicare Coverage Database: Local Coverage Determinations and National Coverage Determinations for payer-specific rules.

Frequently asked

About HCPCS code E0260.

E0260 is the HCPCS Level II code for Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress. It belongs to section E (Durable medical equipment (DME)). Document the supply, drug, or service per the code descriptor and pair with the diagnosis (ICD-10) supporting medical necessity.

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