HCPCS code E0277: Powered pressure-reducing air mattress

## **Documentation requirements for HCPCS code E0277** Coverage for a Group 2 PRSS like E0277 is generally based on the patient's clinical condition and the failure of less aggressive treatment. All documentation must be maintained in the patient's medical record by the treating practitioner and must support the medical necessity of the equipment based on local coverage determination guidelines. Key documentation requirements often include: ### **Physician/treating practitioner's order** A Detailed Written Order (DWO) is required and must include: - Patient's name and Medicare Beneficiary Identifier (MBI). - Supplier's name and National Provider Identifier (NPI). - Date of the order and the treating practitioner's signature. - A complete description of the item (e.g., "Powered pressure-reducing air mattress" or "HCPCS E0277"). - A description of the quantity, frequency of use (e.g., "continuous use"), and duration of need. ### **Medical necessity documentation (clinical criteria)** The medical record must contain sufficient information to support one of the following criteria for a Group 2 PRSS: - **Criterion 1**: The patient has multiple Stage II existing pressure ulcers located on the trunk or pelvis that have worsened or remained the same after being on a comprehensive ulcer treatment program for at least the past 30 days. - **Criterion 2**: The patient has large or multiple Stage III or Stage IV pressure ulcer(s) on the trunk or pelvis. - **Criterion 3**: The patient has had a recent (within the past 60 days) myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis, and they were on a Group 2 or 3 support surface immediately prior to discharge from a hospital or nursing facility (discharge within the past 30 days). ### **Other required documentation** - **Proof of Delivery (POD)**: Documentation showing the item was delivered to and received by the patient. - **Prior Authorization (PA)**: E0277 is included on the Centers for Medicare & Medicaid Services (CMS) Required Prior Authorization List for certain DMEPOS items. When applicable, suppliers must obtain prior authorization before dispensing the item, and claims must include the Unique Tracking Number (UTN) from an affirmative prior authorization decision.

## **HCPCS code e0277 billing requirements** To ensure proper reimbursement for HCPCS code E0277, the following guidelines and requirements must be considered: - For Medicare, a Prior Authorization is typically required for a new rental series for HCPCS code E0277. The request must be submitted to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) and receive an affirmative decision before the item is dispensed and billed. - The appropriate modifier must be used to indicate whether the service is a rental or a purchase, as allowed by the payer's policy (E0277 is commonly a capped rental item). Examples are RR for rental, NU for new equipment, and KX for requirement met. - E0277 is typically billed as a monthly capped rental. Suppliers are reimbursed for a capped number of rental months (e.g., 13 months) after which ownership transfers to the beneficiary, and only maintenance/service is covered. - Claims for E0277 will be denied as a duplicate if the patient already has, or is within the rental period for, another piece of equipment that serves the same purpose (e.g., another Group 2 or Group 3 support surface mattress or overlay).

## **Related HCPCS codes** - **E0193**: Powered air flotation bed (low air loss therapy) - **E0371**: Non-powered advanced pressure-reducing overlay for mattress - **E0372**: Power-pressured reducing mattress overlay (air) - **E0373**: Non-powered advanced pressure-reducing mattress - **E0194**: Air-fluidized bed (This is a Group 3 PRSS, which is a higher level of support, subject to stricter criteria).