HCPCS code E0244: Raised toilet seat billing guide

Key Takeaways

HCPCS code E0244 describes a raised toilet seat, classified under the E0240-E0249 Bathing Supplies DME range.

Medicare does not cover E0244; suppliers must append the GY modifier and issue an ABN when billing Medicare.

Medi-Cal limits E0244 to once every five years; MassHealth accepts modifiers NU and UD with this code.

Pabau’s claims management software helps DME suppliers track non-covered item denials and automate ABN documentation workflows.

HCPCS code E0244 is a Level II HCPCS code that describes a raised toilet seat, a durable medical equipment item in the E0240-E0249 bathing supplies range. It is non-covered by Medicare and requires the GY modifier on every Medicare claim, while some state Medicaid programs cover it under their DME benefit.

This guide covers everything DME suppliers, coders, and clinicians need to bill HCPCS code E0244 correctly: the official code descriptor, Medicare policy, modifier requirements, medical necessity documentation, related codes in the E0240-E0249 range, and state Medicaid variations including Medi-Cal and MassHealth.

What is HCPCS code E0244?

HCPCS code E0244 is a Level II HCPCS code maintained by the Centers for Medicare and Medicaid Services (CMS). Its official long description is “Raised toilet seat” and its short description is “Toilet seat raised.” The code falls within the E0240-E0249 Bathing Supplies range and was added to the HCPCS code set on January 1, 1986.

A raised toilet seat is a durable medical equipment (DME) device fitted over a standard toilet to increase seat height. It assists patients with limited mobility, joint weakness, post-surgical restrictions, or other conditions that make lowering to and rising from a standard toilet height difficult or unsafe.

Classification under Durable Medical Equipment means E0244 is subject to DMEPOS supplier standards and, where applicable, competitive bidding program rules. Suppliers must hold active DMEPOS accreditation to bill this code to any payer that requires it.

Medicare coverage status for HCPCS code E0244

Medicare does not cover HCPCS code E0244. This is not a Local Coverage Determination (LCD) decision that varies by MAC jurisdiction. It is a national non-coverage position confirmed by CMS Policy Article A52461 (Commodes). No amount of additional documentation will make E0244 billable to Medicare as a covered benefit.

CMS Policy Article A52461 also addresses a common workaround attempt: billing a commode chair code when the chair is positioned over the toilet to function as a raised toilet seat. CMS is explicit that this scenario is also non-covered, and the GY modifier must be added to the commode chair code when provided in that manner.

GY modifier: when and how to use it with E0244

The GY modifier signals to the Medicare Administrative Contractor (MAC) that the item is statutorily excluded from Medicare coverage. Suppliers must append GY to HCPCS code E0244 whenever the claim is submitted to Medicare, even if the intent is only to generate a denial for secondary payer or crossover purposes.

• GY modifier definition: “Item or service statutorily excluded, does not meet the definition of any Medicare benefit or, for non-Medicare insurers, is not a contract benefit”
• When to use: All Medicare claims for E0244, including those submitted purely to obtain a Medicare denial for Medicaid crossover billing
• Effect on claim: The claim will be denied as non-covered; the denial letter is required by some secondary payers before they will process the claim
• Commode chair extension: Also apply GY to any commode chair code (such as E0163 or E0165) when the chair is being provided for use as a raised toilet seat over the toilet

Submitting E0244 to Medicare without the GY modifier can generate a false-coverage impression in claim history and may trigger payer audits. Make the GY modifier a default medical billing rule for this code across your team.

Advance Beneficiary Notice (ABN) requirements

Because E0244 is a statutory exclusion rather than a coverage determination that could be met with better documentation, the ABN rules for this code work differently from most non-covered DME items. Suppliers are not required to issue an ABN for items that are statutorily excluded, since there is no scenario in which Medicare would cover them.

That said, many suppliers issue a voluntary ABN for E0244 as a best practice to ensure patients understand they are personally responsible for the cost. This also supports HIPAA-aligned documentation practices by creating a clear paper trail of patient financial consent before delivery.

Documentation requirements for E0244

Because Medicare will not cover E0244 regardless of clinical documentation, the documentation requirements for this code are driven primarily by state Medicaid programs, commercial payers, and internal compliance standards rather than by Medicare LCD criteria.

For payers that do cover a raised toilet seat under their DME benefit, medical necessity documentation typically needs to establish:

• Functional limitation: The patient has difficulty safely lowering to or rising from a standard toilet height due to a documented medical condition
• Diagnosis support: A physician or qualified clinician has documented the underlying condition (see ICD-10 codes below)
• Treating provider order: A written order or prescription from the treating clinician specifying E0244
• Home assessment: Some payers require confirmation that the patient’s home toilet is compatible with the device
• Length of need: Documentation that the need is expected to continue for at least 12 months (where required by payer policy)

Store documentation in digital intake forms linked directly to the patient record so retrieval during a payer audit is immediate rather than manual. Incomplete documentation is the leading cause of post-pay recoupment for DME suppliers, and centralizing records reduces that risk considerably.

Effective patient data security practices also ensure this information is protected in transit and at rest.

ICD-10 diagnosis codes that support medical necessity

When billing E0244 to a payer that does cover it, the accompanying ICD-10-CM diagnosis code must reflect the functional limitation making the raised toilet seat medically necessary. Commonly used diagnosis codes include:

The diagnosis code alone does not establish medical necessity. The clinical notes must connect the diagnosis—for example, ICD-10 code M17.12 for osteoarthritis of the left knee or ICD-10 code M62.81 for generalized muscle weakness—to the functional limitation the raised toilet seat addresses. A chart note that records the diagnosis but does not describe the patient’s specific difficulty with toilet transfers is insufficient for most payers.

Fee schedule and reimbursement rates for E0244

Because Medicare does not cover E0244, there is no published Medicare DME fee schedule rate for this code. Reimbursement depends entirely on the payer covering the item: state Medicaid fee schedules, commercial payer contracts, or self-pay rates set by the supplier.

Suppliers can look up state Medicaid fee schedule rates through each state’s Medicaid billing portal, which publishes allowable amounts for covered DME items. Because rates vary by state and payer, confirm the current allowable directly with the payer before submitting a claim.

For suppliers billing commercial payers under contracted rates, the allowable for a raised toilet seat typically reflects the retail cost of the item with a payer-negotiated margin. Verify your contracted rate for E0244 in your payer agreements before assuming any benchmark figure applies.

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State Medicaid coverage for E0244

State Medicaid programs set their own DME coverage policies independently of Medicare. Several states do cover a raised toilet seat as a Medicaid DME benefit, subject to prior authorization, frequency limits, and medical necessity criteria specific to that state.

California Medi-Cal

Medi-Cal covers E0244 with a frequency limit of one item per five years. This limit applies across the E0240-E0249 bathing supplies range. Suppliers billing Medi-Cal for a raised toilet seat must verify the beneficiary has not received the same item within the preceding five years before submitting a claim.

Massachusetts MassHealth

MassHealth accepts HCPCS code E0244 with modifiers NU and UD. The NU modifier indicates a new item (purchase), while UD indicates the item is provided under a specific MassHealth program. Suppliers should confirm current modifier requirements with the MassHealth DME billing guidelines before submission, as modifier policies can change with annual program updates.

Other state Medicaid programs

Coverage, prior authorization requirements, and frequency limits vary significantly across the remaining states. Some states require prior authorization for any DME item above a threshold cost; others process E0244 claims without pre-approval. Always verify the specific state’s DME billing manual before submitting. Effective medical forms management at your practice helps capture state-specific documentation requirements at intake, reducing back-and-forth with Medicaid billing offices.

Related HCPCS codes in the E0240-E0249 bathing supplies range

E0244 sits within a group of HCPCS codes covering bathroom safety and bathing assistance equipment. Understanding the adjacent codes helps coders select the right code when the item provided differs from a standard raised toilet seat, reducing first-submission errors.

All codes in the E0240-E0249 range carry the same Medicare non-coverage status as E0244. This is a consistent pattern: Medicare considers bathroom safety aids to be convenience or comfort items rather than covered DME. The GY modifier applies to all of them when billing Medicare.

E0244 vs. commode chair codes

A common coding error occurs when a commode chair is dispensed to sit over the toilet rather than as a freestanding commode. As CMS Policy Article A52461 makes clear, a commode chair used in this manner functions as a raised toilet seat and is non-covered just like E0244. The correct approach is to code the commode chair using the appropriate commode code (E0163 for fixed arms, E0165 for detachable arms) and append GY to signal non-coverage. Do not substitute E0244 for the commode chair code simply because the patient is using the chair over the toilet.

Strong EHR integration workflows that link the dispensed item description to the correct HCPCS code at the point of order entry reduce this type of substitution error before it reaches the claim.

How to bill E0244: step-by-step workflow

The billing workflow for E0244 differs depending on whether you are billing Medicare (always non-covered) or a state Medicaid program or commercial payer that may cover it. Here is the standard workflow for each scenario.

Billing E0244 to Medicare

1. Confirm non-coverage: Verify that E0244 is non-covered for this patient’s Medicare plan (including Medicare Advantage plans, which may have different benefit structures).
2. Consider a voluntary ABN: Issue a voluntary Advance Beneficiary Notice so the patient understands they are financially responsible. Obtain a signed copy before delivery.
3. Dispense the item: Provide the raised toilet seat and document the delivery, including the item’s brand and serial/lot number where applicable.
4. Submit with GY modifier: Append modifier GY to E0244 on the claim. The claim will deny, generating the denial letter required by some secondary payers.
5. Bill the patient or secondary payer: Collect from the patient directly, or submit to a secondary payer (such as Medicaid or a Medigap plan) using the Medicare denial as a crossover document.

Billing E0244 to Medicaid or commercial payers

1. Verify coverage: Confirm the payer covers a raised toilet seat under their DME benefit and check frequency limits (for example, Medi-Cal’s five-year limit).
2. Obtain prior authorization if required: Submit the PA request with the treating clinician’s order and supporting diagnosis documentation before dispensing.
3. Collect and file documentation: Gather the written order, ICD-10 diagnosis code(s), and any functional assessment notes required by the payer.
4. Submit the claim: Bill E0244 with appropriate modifiers (for example, NU or UD for MassHealth). Include the ICD-10-CM diagnosis code on the claim.
5. Track and follow up: Monitor for remittance and follow up on any additional documentation requests within the payer’s timely filing window.

Automating the documentation checklist at the point of order entry reduces the chance of missing a required field before the claim is submitted. Primary care compliance checklists offer a useful structural model for building similar checklists for DME billing. For practices managing high volumes of DME orders, automated billing workflows can route each order through required documentation steps before it reaches the claim queue.

DMEPOS supplier requirements for billing E0244

Suppliers billing HCPCS code E0244 to any federal or state payer must meet the DMEPOS supplier standards set by CMS and its Medicare Administrative Contractors. Key requirements include:

• Active DMEPOS accreditation: Suppliers must hold and maintain accreditation from a CMS-approved accrediting organization
• Supplier number: A National Provider Identifier (NPI) with a DMEPOS taxonomy code must be used on all claims
• Delivery documentation: A proof of delivery signed by the beneficiary or authorized representative must be retained
• Record retention: Supplier records for E0244 claims must be retained for a minimum of seven years from the date of service
• Competitive bidding compliance: In competitive bidding areas, suppliers must be contract suppliers for the applicable product category or bill with the correct modifier if exempt

Because E0244 is non-covered by Medicare, DMEPOS accreditation for this item is most relevant for state Medicaid billing and for suppliers that maintain accreditation as a general operational standard. Some commercial payers also require DMEPOS accreditation as a contracting condition.

Conclusion

HCPCS code E0244 is one of the more straightforward HCPCS codes to understand once the Medicare non-coverage position is clear, but it generates a disproportionate share of compliance issues when suppliers forget the GY modifier, skip the voluntary ABN, or confuse it with covered commode chair scenarios.

Pabau’s claims management software helps practices and DME suppliers build payer-specific billing rules, track denial patterns, and automate documentation requirements so E0244 claims reach the right payer with the right modifier from the first submission. To see how Pabau handles DME billing documentation end-to-end, book a demo with the team.

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