MyMedi-AI

E0265 — Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress

HCPCS Level II E-code · short descriptor: “Hosp bed total electr w/ 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.

E0265 Medicare fee schedule (October 2026)

RR — Monthly rental Capped rental

Medicare allowable ranges from $184.01 to $267.38 depending on state and rural status.

StateNon-ruralRural
AK$215.80—
AL$184.01$196.36
AR$184.01$214.77
AZ$184.01$214.77
CA$184.01$214.56
CO$184.01$214.77
CT$184.01$211.02
DC$184.01$214.77
DE$184.01$214.77
FL$184.01$196.36
GA$184.01$196.36
HI$224.39—
IA$184.01$214.77
ID$184.01$214.77
IL$184.01$214.77
IN$184.01$211.44
KS$184.01$214.77
KY$184.01$201.09
LA$184.01$214.77
MA$184.01$214.77
MD$184.01$211.51
ME$184.01$214.77
MI$184.01$205.39
MN$184.01$197.81
MO$184.01$197.67
MS$184.01$206.27
MT$184.01$214.77
NC$184.01$214.77
ND$184.01$214.77
NE$184.01$207.32
NH$184.01$211.53
NJ$184.01$210.00
NM$184.01$206.04
NV$184.01$196.36
NY$184.01$214.77
OH$184.01$214.77
OK$184.01$205.30
OR$184.01$214.77
PA$184.01$214.77
PR$267.38—
RI$184.01$196.36
SC$184.01$196.36
SD$184.01$214.77
TN$184.01$202.45
TX$184.01$214.77
UT$184.01$212.72
VA$184.01$214.77
VI$214.77—
VT$184.01$214.77
WA$184.01$214.77
WI$184.01$212.93
WV$184.01$201.48
WY$184.01$214.77
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 E0265 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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