HCPCS code E0325 – Male jug-type urinal

Key takeaways

HCPCS code E0325 covers a male jug-type urinal of any material, and E0326 covers the female version.

Medicare Part B covers E0325 as durable medical equipment when medical necessity is documented and the supplier is DMEPOS-enrolled.

The KX modifier is required only where the applicable DME MAC LCD or policy article calls for it, so check the LCD for your jurisdiction.

Billing E0325 for a female patient is a frequent denial cause, and it’s easy to prevent at order entry.

Claims management software such as Pabau scrubs each claim for missing details and tracks it from pending to paid.

HCPCS code E0325: Official descriptor and key details

HCPCS code E0325 is the Level II code for “Urinal; male, jug-type, any material.” Plastic and metal versions both bill under it, so the supplier never picks a separate code based on what the product is made of. Medicare Part B covers it as durable medical equipment (DME) when the order and the medical record support it.

The claim goes to a DME Medicare Administrative Contractor (DME MAC), not the physician’s contractor. The supplier must be enrolled for durable medical equipment, prosthetics, orthotics and supplies, known as DMEPOS. The table sets out the code’s key attributes.

Not sure a product belongs under E0325? The Pricing, Data Analysis and Coding (PDAC) contractor issues formal coding decisions for DME products. CGS Medicare’s coding verification lookup tool helps you check a product’s HCPCS code before you bill it.

What E0325 covers and what it does not

E0325 is broad on material and narrow on the item itself. Plastic, polyethylene and metal male urinals all bill under the same code. Knowing what falls outside it matters just as much for clean billing.

Covered under E0325: Male jug-type urinals made of plastic, polyethylene or metal, in any configuration designed for bed-based male urination.

Not covered under E0325:

• Female urinals (bill E0326 instead)
• Bedpans (bill E0275 standard or E0276 fracture, depending on the item)
• Commodes (E0163, E0165 and related commode codes)
• Fracture pans (bill E0276)
• Disposable urinal products (not reusable DME, so not billable as E0325)

Orders often name the item loosely, so it helps to map each toileting item to its code before you bill.

Suppliers sometimes receive orders for a “urinal” that don’t state the patient’s sex. A sex-verification step at intake saves you the cost of a denied claim and a refund request later.

E0325 vs E0326: Choosing the correct urinal code

E0325 is for male patients, and E0326 is for female patients. The two descriptors are otherwise identical, which makes them easy to mix up. A frequent denial cause is billing this male-specific code for a female patient.

Payers check the billed code against the patient’s sex on file. A mismatch is usually caught by a claim edit before anyone reviews the record. Fixing it takes a corrected claim or an appeal with proof of the patient’s sex, which adds weeks to payment.

Medicare coverage and reimbursement for E0325

Medicare Part B covers E0325 under the DME benefit when three conditions hold. The supplier is DMEPOS-enrolled, medical necessity is documented, and the item is for use in the beneficiary’s home. The applicable DME MAC’s Local Coverage Determination (LCD) governs coverage, and the payment amount comes from the CMS DMEPOS fee schedule.

Key Medicare coverage rules for E0325:

• Benefit: The Medicare Part B DME benefit applies, and the beneficiary pays 20% coinsurance after the Part B deductible.
• Supplier enrollment: The supplier must hold an active DMEPOS supplier number. Claims from unenrolled suppliers are denied before clinical review.
• Fee schedule: The DMEPOS fee schedule sets reimbursement, which varies by jurisdiction and is updated annually. Check the current fee there rather than relying on prior-year figures.
• CMN requirement: A formal Certificate of Medical Necessity (CMN) is generally not required for urinals. A signed order from a physician or qualified practitioner, with supporting documentation, usually suffices. Confirm this with the DME MAC for your jurisdiction, as requirements can vary.
• Medicaid and commercial: Coverage and documentation rules differ by state Medicaid plan and commercial payer. Always verify with the specific payer before dispensing.

The CMS HCPCS overview explains how the Level II code set is maintained and updated each year. Check it to confirm that E0325 is still an active code for the current year.

Medical necessity criteria for E0325

Medical necessity for E0325 rests on documentation that the patient can’t use standard toilet facilities because of bed or room confinement. That’s how the DME MAC policy frames it, so check the applicable LCD for the current wording in your jurisdiction. The order must tie that need to a specific condition, and “patient requested urinal” won’t hold up at audit.

The medical record should show:

• A diagnosis that explains why the patient is confined to bed or to a room without a toilet (see the next section)
• A signed order from a physician, nurse practitioner or physician assistant with prescribing authority
• Documentation that the limitation is expected to last for a medically necessary duration
• Confirmation that the item will be used in the patient’s home or another qualifying setting

Good medical billing compliance means keeping the order, the supporting clinical note and the ICD-10 linkage in the patient record before you submit the claim. An auditor who can’t find the order in the file will treat it as if it never existed.

ICD-10 diagnosis codes that support E0325

The ICD-10 codes below are commonly linked to E0325 claims because they describe conditions that can keep a patient from reaching a standard toilet. Every claim needs a linked diagnosis to establish medical necessity. You can check each descriptor in our searchable ICD-10-CM library.

The diagnosis alone doesn’t guarantee coverage. The clinical note must connect it to the functional limitation, the patient’s inability to reach a toilet, to satisfy the LCD. A payer reviewing M54.50 for low back pain will expect detailed clinical justification, while G82.20 for paraplegia speaks for itself.

Modifiers used with HCPCS code E0325

Modifiers on an E0325 claim tell the payer three facts. They show whether the item is purchased or rented and whether medical necessity criteria are met. They also flag whether the patient knows the item may not be covered. Each one carries its own legal and reimbursement implication.

KX needs the most care. It is required only where the applicable DME MAC LCD or policy article calls for it, so check the LCD for your jurisdiction. Appending KX is a legal attestation that the supplier holds documentation supporting medical necessity. Billing it without that documentation is a compliance risk that reaches well beyond an audit finding.

How to bill E0325: Step-by-step claim submission

DME claims for E0325 go to the DME MAC for the beneficiary’s home state, not the physician’s Medicare Administrative Contractor. Getting the claim path right before submission avoids routing errors that delay payment. The medical billing process for DME follows its own workflow, separate from professional or facility claims.

1. Obtain the physician order: Secure a signed order from a treating physician or other qualified ordering practitioner. The order must name the item (male urinal, jug-type), the medical indication, and the patient’s name and date of birth.
2. Verify medical necessity: Confirm the supporting ICD-10 diagnosis code is in the patient record and that the clinical note documents the functional limitation. Check that the patient’s sex on record matches the code you’re billing (E0325 for male).
3. Confirm DMEPOS enrollment: The billing supplier must hold an active DMEPOS supplier number for the applicable DME MAC jurisdiction. Unenrolled suppliers can’t receive Medicare reimbursement for DME.
4. Select the correct modifier: For a new purchase, append NU. Append KX only where the applicable LCD or policy article requires it, and only when the documentation is on file. If you issued an ABN, also append GA.
5. Enter the place of service: Use POS 12 (Home) for items furnished to a beneficiary in their home. Other qualifying settings use the POS code for that facility type.
6. Submit to the DME MAC: File the claim on the CMS-1500 (for non-institutional suppliers) with the correct DME MAC jurisdiction. Include the ordering physician’s NPI in Box 17b and the supplier’s NPI in Box 33.
7. Track and follow up: Monitor the claim through your claims management software until payment or a denial notice arrives. DME MAC processing typically takes 14 to 30 days for clean claims.

Prior authorization requirements for E0325

Urinals (E0325, E0326) are generally not on the CMS list of DME items that need prior authorization before Medicare will pay. Most E0325 claims can therefore go out without pre-approval from the DME MAC. The documentation requirements still apply in full.

Three situations where prior authorization may still apply:

• State Medicaid programs: Many state Medicaid plans require prior authorization for DME items that Medicare does not. Always verify the state’s PA requirements before dispensing to a Medicaid beneficiary.
• Commercial payers: Commercial policies vary widely. Some require PA for any DME item, while others follow Medicare policy. Check the payer’s DME benefit manual or call the payer line before dispensing.
• CMS program updates: CMS updates the list of items subject to prior authorization from time to time. Verify the current list at cms.gov before relying on any earlier guidance, including this article.

Common reasons E0325 claims are denied

Most E0325 denials are preventable. The patterns below come up repeatedly in DME claim audits and coder discussions, and each has a simple fix when it’s caught before submission. Effective denial management workflows deal with them upstream, well before the appeals stage.

• Wrong code for patient sex: E0325 billed for a female patient is a frequent denial cause. The fix is E0326 for female patients, confirmed at order entry before the claim reaches billing.
• Missing physician order: The claim can’t be paid without a valid signed order in the file. A verbal order, an unsigned fax or an order dated after the dispensing date all lead to a denial.
• Insufficient medical necessity documentation: The ICD-10 diagnosis code must be present and linked to the functional limitation in the clinical note. A diagnosis without the documented clinical rationale doesn’t satisfy the LCD.
• Missing or incorrect modifier: Where the applicable LCD requires KX, leaving it off when the documentation is on file leads to a denial. Appending both NU and RR on the same claim is also an error, so choose one.
• Non-enrolled supplier: Billing under the NPI of a supplier that isn’t DMEPOS-enrolled results in a payer-level denial before clinical review. Confirm enrollment status in PECOS before submitting.
• Missing ABN when required: When coverage is uncertain, the supplier must issue an ABN and get it signed before delivery. Without the ABN and the GA modifier, the supplier may be unable to bill the patient if Medicare denies the claim.

How claims management software prevents E0325 denials

Without a pre-submission check, an E0325 error usually surfaces with the denial. Someone reads the remittance, works out that the patient was female or the order was unsigned, and files a corrected claim weeks later.

Pabau, the practice management platform we build, moves that check to before submission. Its claims management tools pre-fill each claim from the invoice and scrub it for missing or invalid details before it goes to your clearinghouse. The signed order and clinical note sit in the same patient record, so the documentation an auditor asks for is already filed.

Every claim is then tracked from pending to paid. A rejected claim is flagged as needing action with the reason attached, so your team fixes the field and resubmits. You spend less time on corrected claims and get paid for urinals and other DME sooner.

Send cleaner DME claims the first time

Pabau checks each claim for missing or invalid details before it reaches your clearinghouse, then tracks it from pending to paid. Rejected claims arrive flagged with the reason, so your team can fix and resubmit them quickly.

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Conclusion

E0325 rewards suppliers who check before they bill. Confirm the patient’s sex, the signed order and the documented confinement at intake, and the denials in this guide rarely happen.

The trade-off is a few minutes of up-front work on a low-cost item. That’s still cheaper than a corrected claim, an appeal and weeks of waiting on a small payment. Treat the LCD for your jurisdiction as the final word on KX and confinement wording, since it can change.

Book a demo to see how Pabau checks each DME claim before it reaches your clearinghouse.

Continue your research

Need to understand DME denial patterns before they hit your claims? Denial management in healthcare covers the systematic approach to reducing claim rejections across payer types.

Want a broader foundation for medical billing compliance? What is medical billing explains the end-to-end revenue cycle process that DME billing plugs into.

Looking for resources on billing compliance requirements? Medical billing compliance outlines documentation standards and audit readiness practices for healthcare billers.

Keeping a DME catalog with its codes? Durable medical equipment list gives you a free DME template with HCPCS codes.

Filing DME claims on paper? CMS-1500 form walks through every box of the claim form, with a free template.

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