MyMedi-AI

E0261 — Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress

HCPCS Level II E-code · short descriptor: “Hosp bed semi-electr w/o mat”

Code system
HCPCS Level II
Family
E — Durable medical equipment
Medicare coverage status
Special coverage instructions apply
DMEPOS payment category
Capped rental
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
MUE unit limit
1
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

E0261 Medicare fee schedule (October 2026)

RR — Monthly rental Capped rental

Medicare allowable ranges from $72.80 to $161.23 depending on state and rural status.

StateNon-ruralRural
AK$120.78—
AL$77.86$113.32
AR$77.86$125.94
AZ$77.50$125.94
CA$74.66$120.00
CO$76.76$125.94
CT$72.80$125.94
DC$74.43$115.74
DE$74.43$125.94
FL$77.86$113.32
GA$77.86$113.32
HI$126.24—
IA$76.74$125.94
ID$76.76$125.94
IL$75.89$125.94
IN$75.89$119.70
KS$76.74$117.13
KY$77.86$113.32
LA$77.86$125.94
MA$72.80$125.94
MD$74.43$115.39
ME$72.80$125.94
MI$75.89$125.94
MN$76.74$113.32
MO$76.74$113.32
MS$77.86$113.32
MT$76.76$125.94
NC$77.86$113.32
ND$76.74$125.94
NE$76.74$113.32
NH$72.80$125.94
NJ$74.43$113.32
NM$77.50$118.65
NV$74.66$125.94
NY$74.43$125.94
OH$75.89$125.94
OK$77.50$125.94
OR$74.66$125.94
PA$74.43$120.84
PR$161.23—
RI$72.80$113.32
SC$77.86$113.32
SD$76.74$125.94
TN$77.86$113.32
TX$77.50$125.94
UT$76.76$125.94
VA$77.86$113.46
VI$125.94—
VT$72.80$125.94
WA$74.66$125.94
WI$75.89$115.97
WV$77.86$116.88
WY$76.76$113.32
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps E0261 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Code Descriptor / CPT Instruction.

Common denial codes to watch

Related E-codes

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