HCPCS code E0245 – Tub stool or bench

Key takeaways

HCPCS code E0245 describes a tub stool or bench used inside the bathtub. Shower chairs, transfer benches and tub rails each carry their own codes.

Medicare does not cover E0245 because it treats bath seating as not primarily medical. No Medicare fee schedule amount exists for the code.

Append the GY modifier on Medicare claims to get the formal denial that a Medicaid or secondary payer may require.

Medicaid, Medicare Advantage and commercial plans may cover E0245 with a written order, documented need and, often, prior authorization.

Pabau, the practice management platform we build, keeps orders, signed notices and claim status on the patient record, so DME claims go out complete.

HCPCS code E0245: Official description and classification

HCPCS code E0245 is the HCPCS Level II code for a tub stool or bench.

This seat lets a patient bathe sitting down inside the tub. It sits in the E0240-E0249 bathing supplies range of the durable medical equipment (DME) E codes. The Centers for Medicare and Medicaid Services maintains the code set and updates it every year.

The descriptor covers a stool or bench that stands inside the tub. It does not cover shower chairs, which bill as E0240. Transfer benches that straddle the tub wall, tub rails and raised toilet seats fall outside it too. Each of those devices has its own code, so check the device design before you choose one.

What E0245 covers and what it does not

Occupational and physical therapists often recommend tub seating for patients with balance or mobility problems. E0245 applies only when that seat stands inside the tub.

Covered under E0245

• Tub stools used for seated bathing inside the tub
• Tub benches whose legs all rest inside the tub
• Height-adjustable tub seats and benches used inside the tub

Not covered under E0245

• Bath or shower chairs, with or without wheels (E0240)
• Bathtub wall rails (E0241)
• Floor-based bathtub rails (E0242)
• Toilet rails (E0243)
• Raised toilet seats (E0244)
• Transfer tub rail attachments (E0246)
• Transfer benches for the tub or toilet (E0247), including heavy-duty models (E0248)
• Non-durable bath aids such as bath mats and sponges

The deciding detail is where the seat sits. If the device straddles the tub wall so the patient can slide across, bill E0247 or E0248 instead of E0245. Name the device type and model in the order so a reviewer can match it to the code.

Medicare coverage status for E0245

Medicare does not cover HCPCS code E0245. CMS treats bath and shower seating as comfort or convenience items that are not primarily medical, so they fall outside the Part B DME benefit.

The exclusion applies nationally. All four DME Medicare Administrative Contractors (MACs) apply it, including Noridian (Jurisdictions A and D) and CGS (Jurisdictions B and C). Medicare has not set a fee schedule amount for the code.

Suppliers still bill E0245 to Medicare in one situation. A Medicaid or secondary payer may need the Medicare denial on file before it will pay.

Payers that may cover E0245

Coverage outside traditional Medicare varies by plan. Check the payer policy before delivery, because the rules differ by state and contract.

• State Medicaid programs: Many cover bath seating as DME when a practitioner documents the need. Prior authorization is common.
• Medicare Advantage plans: Some plans include bathroom safety items as a supplemental benefit. Check the member’s plan documents.
• Commercial insurers: Policies differ widely. Some exclude bath equipment as a convenience item, while others cover it with a letter of medical necessity.

Conditions payers often look for (illustrative, not exhaustive)

• Severe balance disorders or ataxia
• Lower extremity weakness from stroke, multiple sclerosis or Parkinson’s disease
• Post-surgical hip or knee restrictions that make standing in the tub unsafe
• A history of falls while bathing

Required documentation for billing E0245

Clean claims for HCPCS code E0245 depend on a complete documentation package. Gather it before the claim is filed, because a missing element is a common cause of denials.

• Written order: Include the patient’s name, diagnosis, item description, ordering practitioner’s NPI and signature, and the order date. E0245 needs no Certificate of Medical Necessity (CMN), but payers that cover it still expect a written order.
• Supporting ICD-10-CM diagnosis code(s): Link a diagnosis that explains why the patient cannot bathe safely without a seat. The chart notes must support it.
• Proof of delivery: Keep a signed delivery record showing the patient or an authorized representative received the item.
• Supplier enrollment: The supplier needs an active Medicare DMEPOS supplier number to bill Medicare, even for a denial. Medicaid and commercial plans set their own enrollment rules.
• Patient notice: An Advance Beneficiary Notice of Noncoverage (ABN) is not required for items Medicare excludes by law. Many suppliers still give a voluntary notice so the patient knows they will pay.

Pabau’s digital intake forms capture patient signatures and attach documents to the patient record at the point of care. Orders, notices and delivery records stay together when the claim reaches billing.

Applicable modifiers for HCPCS E0245

The modifier on an E0245 claim tells the payer why the item is billed and how it was supplied. On Medicare claims the choice is simple, because the item is never covered.

Payer rules differ, so check each Medicaid or commercial policy for its own modifier list. Some state programs also require a purchase or rental modifier on every DME line.

Reimbursement for E0245: Fee schedule status and other payers

Medicare has not set a fee schedule amount for HCPCS code E0245. Because the item is non-covered, the DMEPOS Competitive Bidding Program does not apply to it either. Check the CMS DMEPOS fee schedule files each January in case the status changes.

Payment therefore depends on the patient’s other coverage:

• Traditional Medicare only: The patient pays the supplier’s charge. A GY claim shows that Medicare denied the item, which some supplemental plans need.
• Medicaid: Each state sets its own DME fee schedule and may limit how often it pays for bath seating.
• Medicare Advantage: Plans that cover bathroom safety items set their own allowances, often through a contracted supplier network.
• Commercial insurers: Allowable amounts follow the insurer’s contract. Verify the fee and any prior authorization before delivery.

The chart below puts coverage, modifiers, paperwork and payment for each payer side by side, so you can route an order before delivery.

Codes commonly confused with E0245

E0245 shares the E0240-E0249 bathing supplies range with codes that have similar descriptions. Picking the wrong one is a common error on bath equipment claims, and it means a correction and a resubmission. Use the comparison below before you bill.

E1399 deserves special attention. It is a miscellaneous DME code for devices with no specific HCPCS code. Billing E1399 when E0245 applies is a coding error that leads to a denial or a request for more information. If you are unsure whether a device fits E0245, check the AAPC HCPCS code lookup or the CMS HCPCS coding system page first.

Common denial reasons and how to appeal an E0245 claim

A Medicare denial for E0245 is expected, so there is no error to fix. The denials worth working come from Medicaid, Medicare Advantage and commercial payers, or from Medicare claims billed incorrectly. Pabau’s claims management software tracks each claim’s status, so billing staff can spot a denial and route it for correction quickly.

Top denial reasons

• Wrong code: A transfer bench was billed as E0245, or a tub bench as E0240. Resolution: match the code to the device design and resubmit.
• Missing GY modifier on a Medicare claim: Without GY, the denial can take longer and patient liability is less clear. That delays the secondary payer. Resolution: add GY and resubmit.
• Missing or incomplete order: The order lacks a required element or was not on file before delivery. Resolution: obtain a complete order, following the payer’s rules on late orders.
• Medical necessity not shown: The diagnosis on a Medicaid or commercial claim does not explain why the patient needs a seat. Resolution: request a letter of medical necessity and resubmit with chart notes.
• No prior authorization: The payer required approval before delivery and none was on file. Resolution: ask whether the payer allows retroactive authorization; if not, the denial usually stands.
• Supplier enrollment issue: The supplier number is invalid or revoked, or the supplier does not meet the DMEPOS Supplier Standards. Resolution: verify enrollment status in PECOS (Provider Enrollment, Chain, and Ownership System) before resubmitting.

Appeal steps

1. Read the remittance advice and note the claim adjustment reason code (CARC) and remittance advice remark code (RARC).
2. Match the codes to the correction actions listed above.
3. Assemble the corrected documentation and write a short appeal letter citing the payer policy that supports coverage.
4. File within the payer’s deadline. For Medicare, a redetermination request is due within 120 days of the initial determination.
5. If the first appeal is upheld, move to the payer’s next appeal level.

Appealing a Medicare denial for E0245 rarely makes sense, because the exclusion applies nationwide. Send the GY denial to the secondary payer instead. Our guide to medical billing denial codes explains the CARC and RARC codes on other payers’ remittances.

Prior authorization

E0245 is not on the CMS required prior authorization list for DMEPOS, because Medicare does not cover it. Many state Medicaid programs and commercial payers do require prior authorization for bath seating. Confirm the rule with each payer before you deliver the item.

How Pabau’s claims management software supports E0245 billing

Many DME billing teams track bath equipment orders across spreadsheets, email and paper forms. Orders, delivery receipts and patient notices end up in different places, and claims go out incomplete.

Pabau keeps that work on the patient record. Patients sign orders and notices through digital forms, staff attach clinical documents, and claims management tracks each claim from submission to payment.

The result is fewer denials caused by missing paperwork and faster follow-up when a payer does deny a claim. Your team spends less time rebuilding files and more time on the next order.

Manage DME billing documentation in one place

Pabau’s claims management software keeps orders, signed patient notices and claim status on one patient record. Billing teams send complete DME claims and follow up on denials faster.

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Conclusion

HCPCS code E0245 is easy to assign once you confirm the seat stands inside the tub. Payment is the harder part. Traditional Medicare will not pay for a tub stool or bench, so treat every Medicare claim as a GY denial and tell the patient early.

The payment comes from Medicaid, Medicare Advantage and commercial plans. Win those claims by matching the code to the device, checking prior authorization and sending a complete documentation package the first time.

Book a demo to see how Pabau helps DME suppliers and therapy practices send complete claims and follow up on denials faster.

Continue your research

Billing a transfer bench instead? HCPCS code E0247: Transfer bench billing guide explains the code for benches that straddle the tub wall.

Supplying a shower chair? HCPCS code E0240: Bath/shower chair billing guide covers chair-style bath seating, with or without wheels.

Adding a raised toilet seat to the order? HCPCS code E0244: Raised toilet seat walks through the same GY modifier workflow.

Fitting a tub wall rail as well? HCPCS code E0241: Bath tub wall rail billing guide covers billing for bathtub wall rails.

Supplying a heavy-duty transfer bench? HCPCS code E0248: Heavy-duty transfer bench covers the higher-capacity version of E0247.

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