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Every policy word on this page is CMS's own. Verzi adds pins, receipts, and links only.

E0294

Hospital Beds And Accessories

LCD L33820 · CMS's HCPCS descriptor for E0294: Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress.

Not on CMS's Required Prior Authorization List for DMEPOS on 2026-10-13. source

LCD L33820 · 7 versions, 2015 to today · last changed 2020-01-01 (R6)

Version 12 of LCD L33820: in force by CMS's dates 2017-01-01 to 2019-12-31. The policy text on this page comes from this archived version. On its start date, 2017-01-01, the companion Articles in force were Article A52508 version 29 and Article A55426 version 12.

DME MAC jurisdictions
JA · Noridian 16013
CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI, VT
JB · CGS 17013
IL, IN, KY, MI, MN, OH, WI
JC · CGS 18003
AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC, TN, TX, VI, VA, WV
JD · Noridian 19003
AK, AS, AZ, CA, GU, HI, ID, IA, KS, MO, MT, NE, NV, ND, MP, OR, SD, UT, WA, WY
source

CMS's Who are the MACs jurisdiction pages (DME facts as of 2025-09-30) name each contractor and its states; the MCD's Contractor Information table on every DME LCD prints the contract numbers. Both read 2026-10-09. Verzi adds the state lookup only.

You are viewing version 12 (2017-01-01 to 2019-12-31). Version 21 is in force today.

Codes CMS lists in this LCD's current version (version 21, 36 codes). CMS's download carries no list for version 12: E0250 E0251 E0255 E0256 E0260 E0261 E0265 E0266 E0271 E0272 E0273 E0274 E0280 E0290 E0291 E0292 E0293 E0294 E0295 E0296 E0297 E0301 E0302 E0303
12 more codes

Sections in this version: CMS National Coverage Policy · Coverage Indications, Limitations, and/or Medical Necessity · Coding Information · Associated Information. Plus 4 sections marked N/A in this version.

Full verbatim text serves to customers · Customer? Log in

Version history, LCD L33820

CMS numbers each version. Each box shows the version's window by CMS's stated dates. Select a version to show it on this page. Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask. Version numbers CMS never published to its archive do not exist as documents.

Revision history, every version

CMS's own change log, quoted, 6 entries. It does not change with the version shown. A revision (R-number) is a change CMS logged. The version (vN) is the snapshot that carries it.

R6 · 2020-01-01 · v21
Revision Effective Date: 01/01/2020
CODING INFORMATION:
Removed: Field titled “Bill Type”
 Removed: Field titled “Revenue Codes”
Removed: Field titled “ICD-10 Codes that Support Medical Necessity”
Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity”
Removed: Field titled “Additional ICD-10 Information”
As required by CR 10901, the ICD-10 information has been moved to all Policy Articles. There is no change in coverage.
R5 · 2020-01-01 · v18
Revision Effective Date: 01/01/2020
 COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
 Revised: Order information as a result of Final Rule 1713
 DOCUMENTATION REQUIREMENTS:
 Revised: “physician’s” to “treating practitioner’s”
 GENERAL DOCUMENTATION REQUIREMENTS:
 Revised: “Prescriptions (orders)” to “SWO”


02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.
R4 · 2017-01-01 · v12
No changes have been made to this LCD


04/05/2018:
At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
R3 · 2017-01-01 · v10
Revision Effective Date: 01/01/2017
COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: Standard Documentation Language
Added: New reference language and directions to Standard Documentation Requirements
Added: General Requirements
HCPCS CODES:
Revised: HCPCS long descriptors for E0292, E0293, and E0296
DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: General Documentation Requirements
Added: New reference language and directions to Standard Documentation Requirements
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: Direction to Standard Documentation Requirements
Removed: Information under Miscellaneous and Appendices
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements article
R2 · 2016-07-01 · v7
Effective July 1, 2016 oversight for DME MAC LCDs is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the LCDs.
R1 · 2015-10-01 · v4
Revision Effective Date: 10/01/2015
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary’s Medicare eligibility
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
Added: Instructions for Equipment Retained from a Prior Payer
Added: Repair/Replacement section
Receipts for auditors

Version 12 of LCD L33820, shown on this page: in force by CMS's dates 2017-01-01 to 2019-12-31. Archived 2026-09-26. CMS's copy · Our archived file. 8 of 8 sections are proven word-identical to the archived file.

Every archived version of LCD L33820 (7 versions, CMS's dates, window by the as-of rule).

DocumentVersionIn forceArchived onVerify
LCD L33820version 22015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33820version 42015-10-01 to 2016-06-302026-09-26CMS's copy · Our archived file
LCD L33820version 72016-07-01 to 2016-12-312026-09-26CMS's copy · Our archived file
LCD L33820version 102017-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33820version 12 shown2017-01-01 to 2019-12-312026-09-26CMS's copy · Our archived file
LCD L33820version 182020-01-01, superseded same day2026-10-09CMS's copy · Our archived file
LCD L33820version 212020-01-01 to today2026-09-26CMS's copy · Our archived file

The related Articles each have their own receipts: Article A55426 · Article A52508.

Each archived file's page gives its sha256 fingerprint. A copy of the file hashes to the same value, byte for byte.

CMS's live page shows only the current version. To check a passage by eye, open CMS's copy of the same version number. A version's window ends on the earlier of CMS's stated end date and the day before the next version starts.

Every policy word on this page is CMS's, from the archived version named beside it. Verzi adds labels, highlights, citations and links only. Verzi-written summary content on this page: none.

Governing policies, as CMS lists them:

  • LCD L33820 · Hospital Beds And Accessories
    CMS lists E0294 in group 3 of version 21. CMS's description, quoted: “HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS, WITH MATTRESS”.
    Related Articles, as CMS lists them: Article A55426 · Article A52508

From CMS's LCD code table. HCPCS Level II codes only.

source

CMS's LCD code table in the Medicare Coverage Database download, archived 2026-10-09: Our archived file.

Watch E0294

One email when any policy cited for E0294 changes or gains a future effective date. Nothing else, ever.