Summary & Overview
HCPCS E0260: Semi-Electric Hospital Bed with Mattress
HCPCS Level II code E0260 represents a semi-electric hospital bed with head and foot adjustment, side rails, and mattress. As a common durable medical equipment (DME) item, this bed supports patients who need adjustable positioning for comfort, mobility assistance, pressure injury prevention, or clinical care in institutional and home settings. Nationally, coverage and utilization of E0260 influence long-term care, home health, and durable medical equipment supply chains.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage considerations, coding context, and the clinical role of semi-electric hospital beds. The report outlines typical sites of service and service type, summarizes payer handling where available, and identifies where data is not provided.
This publication is designed to help billing managers, DME suppliers, and policy analysts understand how HCPCS Level II code E0260 is characterized, what clinical needs it addresses, and what elements to consider when documenting and submitting claims. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code E0260 describes a hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress. This DME (durable medical equipment) item is intended to provide adjustable support for patients who require positional changes for comfort, pressure redistribution, or clinical care needs.
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Service type: Durable medical equipment — semi-electric hospital bed with mattress and side rails
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Typical site of service: Inpatient or home medical settings where a hospital-style bed is required, including skilled nursing facilities, long-term care, and home health environments
Clinical & Coding Specifications
Clinical Context
A patient with limited mobility is discharged from an acute care hospital to home with home health services following hip fracture surgery. The patient requires a safe, adjustable bed to reduce fall risk, facilitate pressure redistribution, and allow caregiver assistance for transfers and positioning. A physical therapist documents ongoing need for head and foot elevation to assist pulmonary clearance and reduce orthostatic stress; occupational therapy documents need for side rails to assist repositioning and caregiver transfers. The durable medical equipment supplier arranges delivery of a semi-electric hospital bed, coded as E0260, at the patient’s residence. The clinical workflow includes physician or advanced practice clinician assessment and order for the bed, documentation of medical necessity in the plan of care (including functional limitations, weight-bearing status, and home environment), prior authorization/benefit verification with the patient’s insurer, delivery and setup by the supplier, patient/caregiver education on bed controls and rail use, and follow-up visits by home health clinicians to document continued need or modification of equipment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
KA | Data not available in the input. | Data not available in the input. |