Summary & Overview
HCPCS E0261: Semi-Electric Hospital Bed, Head and Foot Adjustment
HCPCS Level II code E0261 represents a semi-electric hospital bed (adjustable head and foot) with side rails, supplied without a mattress. This durable medical equipment code matters nationally because it pertains to hospital-style beds used across inpatient, post-acute, and home settings for patients requiring positional support and enhanced safety features. Coverage and payment for E0261 influence facility and home medical equipment budgets, discharge planning, and supply chain decisions.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, alongside the payer scope covered in the analysis. The publication provides benchmarks for utilization and coverage policy themes, notes common billing and documentation considerations, and highlights where national payer policies intersect with clinical need for semi-electric hospital beds.
This summary equips clinicians, billing professionals, and policy analysts with the essential context for E0261, including what the code denotes, which major payers are relevant, and what types of insights the full publication contains (coverage landscape, billing practices, and operational implications). Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code E0261 describes a hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress. This item is a durable medical equipment product intended to provide adjustable head and foot positioning for patients who require inpatient-style support but may receive the bed in a range of care settings.
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Service type: Durable medical equipment for medical necessity related to patient positioning and support
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Typical site of service: Hospitals, skilled nursing facilities, long-term care facilities, and patient homes when a hospital-style semi-electric bed is prescribed
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with limited mobility following an acute hospital admission for a neurological event (for example, stroke) or progressive neuromuscular disease (for example, amyotrophic lateral sclerosis) who requires a semi-electric hospital bed for home use to support safe positioning, pressure redistribution, and caregiver transfer. The durable medical equipment (DME) supplier receives a physician order specifying E0261 — a semi-electric hospital bed (head and foot adjustment) with any type side rails, without mattress — after discharge planning or during an outpatient DME assessment. The supplier verifies medical necessity, documents baseline functional status, performs a home assessment for space and caregiver needs, arranges delivery and setup, and provides patient/caregiver training on operation, side-rail use, and safe transfer techniques. Replacement or rental billing uses E0261 per payer rules; the mattress is billed separately if clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Used when no specific modifier applies to the claim for E0261. |