Summary & Overview
HCPCS E0272: Mattress, Foam Rubber
HCPCS Level II code E0272 designates a foam rubber mattress used as durable medical equipment to provide basic pressure redistribution and support for patients with limited mobility. Nationally, accurate coding for therapeutic mattresses affects coverage determinations, claim adjudication, and access to appropriate supportive surfaces for patients in home and institutional settings. This analysis covers common national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of what E0272 represents, typical sites of service, and the clinical context in which a foam rubber mattress is used. The publication outlines how payers commonly handle coverage and billing for basic therapeutic mattresses, summarizes available billing benchmarks where present, and highlights policy considerations and documentation expectations that influence payment. Where specific payer guidance is not available in the input, the text will note that data is not provided. The goal is to clarify the purpose of HCPCS Level II code E0272 and what stakeholders should expect when this mattress is billed across major national payers.
Billing Code Overview
HCPCS Level II code E0272 describes a mattress, foam rubber. This code represents a durable medical equipment item intended to provide pressure distribution and basic support for patients with mobility limitations or risk of pressure injury.
Service type: Durable medical equipment (DME), therapeutic mattress
Typical site of service: Home, long-term care facility, skilled nursing facility, or inpatient settings where a therapeutic mattress is supplied for patient use.
Clinical & Coding Specifications
Clinical Context
A homebound adult with limited mobility and risk of pressure injury is evaluated by a primary care physician or wound care specialist. The clinician documents medical necessity for a pressure-relieving surface due to conditions such as stage 2 pressure ulcer on the sacrum, chronic immobility from advanced neurologic disease, or severe rheumatoid arthritis limiting repositioning. The prescription for a foam mattress (E0272) is written by the treating clinician and forwarded to a durable medical equipment (DME) supplier. The DME supplier verifies patient eligibility with the payor (Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare), obtains prior authorization if required, arranges delivery to the patient’s residence or long-term care facility, and provides basic patient education on mattress use and maintenance. Follow-up occurs with the ordering clinician and wound care team to assess skin integrity and therapy effectiveness, with documentation of continued medical necessity for ongoing coverage if the mattress remains required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | (No modifier) Standard reporting | Use when no special circumstances modify the service. |