Summary & Overview
HCPCS E0265: Total Electric Hospital Bed with Mattress
HCPCS Level II code E0265 designates a fully electric hospital bed with head, foot, and height adjustments, side rails, and an included mattress. This equipment supports medically necessary positioning, pressure management, and caregiver tasks across institutional care settings. Nationally, billing and coverage for electric hospital beds affect hospital, long-term care, and durable medical equipment supply chains and are relevant to post-acute care resource planning.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of what the code represents, typical sites of service, and the clinical contexts in which a fully electric hospital bed is used. The publication summarizes how payers commonly handle coverage for hospital beds, presents benchmark considerations for utilization and billing, and outlines relevant policy and coding guidance where available.
This analysis is written for a national audience and provides operational clarity for billing staff, DME suppliers, hospital discharge planners, and policy analysts seeking concise guidance about HCPCS Level II code E0265 and its role in delivering institution-based patient support.
Billing Code Overview
HCPCS Level II code E0265 describes a hospital bed, total electric with head, foot, and height adjustments, equipped with any type of side rails and including a mattress. This durable medical equipment item is intended to support patients who require adjustable positioning for medical care, mobility assistance, pressure relief, or caregiver access.
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Service type: Durable Medical Equipment (DME) hospital bed (electric, fully adjustable)
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Typical site of service: Inpatient settings such as hospitals, long-term acute care facilities, long-term care and skilled nursing facilities, and other institutional care locations where a full electric hospital bed with mattress is required.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with limited mobility, complex medical needs, or recent major surgery who requires a full-electric hospital bed for safe positioning, pressure redistribution, and caregiver handling at home or in a skilled nursing facility. The durable medical equipment order for E0265 is initiated by a treating physician or advanced practice clinician after an in-person evaluation documenting medical necessity (e.g., inability to safely reposition in a standard bed, need for frequent head/foot elevation to manage respiratory compromise or edema, or need for height adjustment to facilitate transfers).
The clinical workflow: the clinician documents mobility limitations, skin integrity risk, respiratory or cardiac indications, and home environment factors. A DME supplier verifies the prescription, conducts a home assessment, delivers and sets up the E0265 total electric hospital bed with mattress, trains patient and caregiver on operation and safety (including side rails), and records delivery and education in the patient record. Follow-up visits or durable medical equipment reassessments occur as clinically indicated to document ongoing medical necessity and maintenance needs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
52 | Reduced services |