Summary & Overview
HCPCS E0295: Hospital Bed, Semi-Electric (Head and Foot Adjustment)
HCPCS Level II code E0295 designates a semi-electric hospital bed that provides head and foot adjustment but is supplied without side rails or a mattress. The code matters nationally because hospital beds are essential durable medical equipment (DME) used across inpatient, skilled nursing, and home health settings to support patient positioning, pressure management, and functional care needs. Proper coding affects DME coverage determinations, inventory management, and clinical care planning.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise presentation of what E0295 represents, the clinical contexts where the bed is used, and the typical service settings. The publication summarizes benchmarks and payment context where available and highlights policy considerations relevant to DME coding and coverage nationally. The content also covers common modifiers and administrative notes where applicable. Data not available in the input is noted explicitly where relevant.
Billing Code Overview
HCPCS Level II code E0295 describes a hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress. This item is a durable medical equipment product intended to provide adjustable head and foot positioning through semi-electric controls, typically operated in acute care, long-term care, or home health settings where a patient requires position adjustment but not full electric bed functionality.
Service type: Durable Medical Equipment (hospital bed)
Typical site of service: Hospital inpatient units, skilled nursing facilities, and patient residence for home health care
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with limited mobility and medical need for an adjustable hospital bed at home or in a long-term care facility. The patient may be recovering from major surgery (for example, hip or abdominal surgery), have progressive neuromuscular disease, advanced cardiac or pulmonary disease requiring frequent head elevation, or complex wound care requiring foot-of-bed adjustments. A durable medical equipment (DME) provider delivers and sets up a semi-electric hospital bed (E0295) without mattress or side rails.
Clinical workflow: The ordering clinician documents medical necessity and selects the appropriate ICD-10 diagnosis. The DME supplier verifies insurance coverage, obtains prior authorization if required, schedules delivery, performs home assessment for space and safety, assembles the semi-electric bed, provides basic user instruction to patient/caregiver on head and foot adjustments and safe use, and documents delivery and beneficiary signature. Follow-up visits or remote checks ensure correct use and address accessory needs such as a compatible mattress, bed rails, or specialized overlays which are billed separately if indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Use when no applicable modifier is reported or payer requires default placeholder |
22 | Increased procedural services | Use when delivery or setup required substantially greater effort than typical (rare for standard DME deliveries) |
52 | Reduced services | Use if a service was partially furnished or abbreviated delivery/setup occurred |
53 | Discontinued service | Use if delivery/setup begun but canceled for clinical reasons |
62 | Two surgeons | Rare; use if two qualified suppliers/providers share responsibility during complex installation requiring clinical supervision |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure | Not commonly applicable; reserved for clinical procedures related to the patient condition when supplier coordination affects billing |
80 | Assistant at surgery | Not typically applicable for DME; included when clinical personnel assist in bedside installation in institutional settings |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist | Use when a PA/NP/CNS is the ordering or supervising clinician as required by payer rules |
RB | Replacement of durable medical equipment - but still under functional repair policy | Use when billing for replacement unit of the same model under justified clinical need |
RR | Replacement of rental DME | Use when converting from rental to purchase or replacing a rented unit per payer policy |
TC | Technical component | Use when billing separates technical services (equipment supply) from professional components; for DME suppliers typically the technical component is billed |
UE | Items provided under the Payer’s home infusion or other special program | Use when payer requires this modifier for items furnished under specific care programs |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
103K00000X | Physical Therapist | Evaluates mobility needs and bed height/adjustment requirements |
225100000X | Home Health Agency | Coordinates home-based equipment delivery and patient training |
251B00000X | DME Supplier | Orders, supplies, and sets up E0295 hospital beds |
207Q00000X | Family Medicine Physician | Common ordering provider for home DME based on chronic conditions |
208D00000X | Orthopedic Surgeon | May order bed for post-operative patients requiring head/foot adjustments |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M16.11 | Unilateral primary osteoarthritis, right hip | Hip osteoarthritis causing limited mobility and need for head/foot adjustment for comfort and transfers |
M17.11 | Unilateral primary osteoarthritis, right knee | Advanced knee OA limiting mobility; adjustable bed improves positioning and facilitation of transfers |
I50.21 | Acute on chronic systolic (congestive) heart failure | Head-of-bed elevation required for respiratory comfort and to reduce orthopnea, supporting use of an adjustable bed |
J96.01 | Acute respiratory failure with hypoxia | Patients requiring frequent position changes and head elevation for oxygenation may need semi-electric beds for safe positioning |
G82.20 | Paraplegia, unspecified | Patients with spinal cord injury or paralysis frequently require adjustable beds for pressure management and transfers |
L89.309 | Pressure ulcer of sacral region, unspecified stage | Position changes and foot elevation facilitated by adjustable beds to offload pressure and assist wound care |
M54.5 | Low back pain | Severe functional impairment may justify an adjustable bed to improve comfort and sleep and facilitate care |
R26.2 | Difficulty in walking, not elsewhere classified | Mobility impairment that supports need for a semi-electric hospital bed to assist with transfers and positioning |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99401 | Preventive medicine counseling, individual, approximately 15 minutes | May be used for documented patient/caregiver education on bed safety and fall prevention during a home visit prior to or after delivery |
99213 | Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity | Commonly used by ordering clinicians to document the medical necessity evaluation supporting the order for a semi-electric hospital bed |
96161 | Administration of caregiver-focused health risk assessment instrument | May be used when a caregiver assessment is performed to ensure safe operation and home suitability for the bed |
99501 | Home visit for new patient (physician) | Used when an in-home clinical evaluation is performed before ordering DME to document need and environment |
97001 | Physical therapy evaluation | May be performed to document functional deficits and justification for adjustable hospital bed features |