Does E0261 require prior authorization?

Yes, E0261 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

`E0261`, Hospital bed, semi-electric (head and foot adjustment), with any type side

HCPCS/CPT

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for items addressed in this policy.
For DMEPOS base items that require WOPD, the supplier must have received a signed WOPD prior to delivery of the item.
For DMEPOS base items with separately billed associated options/accessories/supplies, the WOPD must list the base item (and may list accessories) prior to delivery and separate billing of those items.

An item is covered if it is an eligible Medicare benefit, is reasonable and necessary for diagnosis or treatment (meets SSA §1862(a)(1)(A)), and satisfies all other Medicare statutory and regulatory requirements.
A fixed-height hospital bed (E0250, E0251, E0290, E0291, E0328) is covered when the beneficiary has a medical condition requiring positioning of the body in ways not feasible with an ordinary bed.
A fixed-height hospital bed is covered when the beneficiary requires head-of-bed elevation >30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or aspiration risk.
A fixed-height hospital bed is covered when the beneficiary requires specific body positioning to alleviate pain that cannot be achieved with an ordinary bed.
A fixed-height hospital bed is covered when the beneficiary requires traction equipment that can only be attached to a hospital bed.
A variable-height hospital bed (E0255, E0256, E0292, E0293) is covered if the beneficiary meets any fixed-bed criterion and requires a bed height different from a fixed-height bed to permit transfers to a chair, wheelchair, or standing position.

SUREST-POL-SUREST-beds-mattresses-sur, Beds and Mattresses – Surest Medical Policy

ANTHEM-CG-DME-15, Hospital Beds and Accessories

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

L33820, Hospital Beds And Accessories

UHC-POL-beds-mattresses, Beds and Mattresses

BCBSIL-DME101.001, Hospital Beds and Related Equipment

BCBSMT-DME101.001, Hospital Beds and Related Equipment

BCBSNM-DME101.001, Hospital Beds and Related Equipment

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UMR-POL-UMR-beds-mattresses, Beds and Mattresses