Does E0272 require prior authorization?

No, E0272 does not require prior authorization (high confidence). Covered without prior authorization.

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`E0272`, Mattress, foam rubber

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.
Suppliers are required to maintain proof of delivery (POD) documentation and make it available to the Medicare contractor upon request.

Key Coverage Criteria

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.

8 Active Policies

HUMANA-MEDICAL-SUPPLIES-EQUIPMENT-AND-APPLIANCES-DURABLE-MEDICAL-EQUIPMENT-VA-MEDICAID, Medical Supplies, Equipment and Appliances Durable Medical Equipment

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

ANTHEM-CG-DME-16, Pressure Reducing Support Surfaces - Groups 1, 2 & 3

L33820, Hospital Beds And Accessories

BCBSIL-DME101.001

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E0272, Mattress, foam rubber