HCPCS code E0373 – Advanced pressure-reducing mattress

Key takeaways

HCPCS Code E0373 is a nonpowered advanced pressure-reducing mattress, a Group 2 support surface that replaces the existing mattress instead of overlaying it.

Medicare covers E0373 under LCD L33642 only when the patient meets one of three Group 2 criteria built around trunk or pelvic pressure ulcers.

E0373 has been on the CMS Required Prior Authorization List nationwide since October 21, 2019, so request prior authorization before delivery.

Only products listed under E0373 on the PDAC Product Classification List may be billed with this code.

E0373 is billed as a capped rental with RR and a KH, KI or KJ modifier, plus KX when the LCD criteria are met.

HCPCS Code E0373: definition and official descriptor

HCPCS Code E0373 describes a nonpowered advanced pressure reducing mattress. It is a full mattress replacement that can be placed directly on a hospital bed frame. It sits in the Group 2 tier of pressure reducing support surfaces, which Medicare reserves for patients with serious pressure ulcers.

The code is part of the HCPCS Level II system, and Policy Article A52490 sets the product characteristics. An E0373 mattress uses cells whose height and design give significantly more pressure reduction than a Group 1 mattress and prevent bottoming out.

Its total height is 5 inches or greater, and its surface is designed to reduce friction and shear. The manufacturer also needs documented evidence that the product works for the conditions in the Group 2 coverage criteria. Heavy duty and bariatric versions are included in E0373.

What E0373 covers and what it does not

E0373 covers a nonpowered mattress that takes the place of the patient’s existing mattress and meets the A52490 specifications. Several products that look similar in a supplier catalog bill under other codes.

• Nonpowered overlays: an advanced overlay placed on top of an existing mattress, with a total height of 3 inches or more, bills under E0371.
• Powered air overlays: an overlay driven by a pump or blower, with an inflated cell height of 3.5 inches or more, bills under E0372.
• Powered air mattresses: a full replacement mattress with alternating pressure, low air loss, or powered flotation bills under E0277.
• Group 1 surfaces: standard pads and overlays, such as the alternating pressure pad with pump billed under E0181, follow the Group 1 rules instead.
• Unlisted products: a mattress without a PDAC coding verification review under E0373 cannot be billed with this code, even when its specifications match.

E0373 vs E0371, E0372 and E0181: which code applies?

Two questions settle most coding decisions in this group, and the grid below maps the four answers. Does the product replace the mattress or sit on top of it? And does it run on a pump or blower?

The most common miscoding is billing E0373 for a nonpowered overlay that sits on top of the existing mattress. That product is E0371, and its PDAC listing will say so.

A second error is reaching for E0372 because it sits next to E0373 in the code list. E0372 is a powered air overlay, so it never describes a nonpowered mattress. Check the product against the PDAC Product Classification List before you choose a code.

Medicare coverage criteria for HCPCS Code E0373

Medicare covers E0373 when the patient meets at least one of three criteria in LCD L33642, Pressure Reducing Support Surfaces, Group 2.

• Failed stage 2 care: multiple stage 2 pressure ulcers on the trunk or pelvis that have not improved over the past month. The patient must have been on a comprehensive ulcer treatment program throughout.
• Advanced ulcers: large or multiple stage 3 or 4 pressure ulcers on the trunk or pelvis.
• Recent flap or graft: a myocutaneous flap or skin graft for a trunk or pelvic pressure ulcer within the past 60 days. The patient must also have used a Group 2 or 3 surface right before a hospital or nursing facility discharge in the past 30 days.

The comprehensive program in the first criterion has six required parts:

• Use of an appropriate Group 1 support surface
• Regular assessment by a nurse, practitioner, or other licensed healthcare practitioner
• Appropriate turning and positioning
• Appropriate wound care
• Appropriate management of moisture and incontinence
• Nutritional assessment and intervention consistent with the overall plan of care

After a flap or graft, coverage is generally limited to 60 days from the date of surgery. Otherwise, continued use is covered until the ulcer heals.

If healing stalls, the record must show the care plan is being modified, or that the surface is still reasonable and necessary for wound management. Ulcers on the heels, elbows, or other sites outside the trunk and pelvis do not meet the Group 2 criteria.

Covered ICD-10 diagnosis codes for E0373

Policy Article A52490 lists the covered diagnoses, and each one is an L89 pressure ulcer code for the back, sacral region, hip, or buttock. The table shows examples, and the Policy Article’s full list controls what the DME MAC accepts.

The list has no codes for heel, elbow, or other sites outside the trunk and pelvis. Risk-factor codes such as paraplegia or cachexia do not qualify on their own either. Group 2 coverage turns on an existing ulcer or a recent flap or graft.

Documentation requirements: standard written order and medical records

E0373 claims need no certificate of medical necessity. They rest on a standard written order and medical records that show the patient meets LCD L33642. Good DME billing compliance starts with this file:

1. Standard written order: communicated to the supplier before the claim goes out. It names the patient, the order date, the item, the quantity, and the treating practitioner, with their signature.
2. Wound documentation: the stage, site, and size of each ulcer, taken from the treating practitioner’s or nurse’s notes.
3. Comprehensive program record: for the stage 2 criterion, notes showing a month on the six-part program without improvement.
4. Surgery and discharge record: for the flap or graft criterion, the surgery date and the Group 2 or 3 surface used before discharge.
5. Care plan: established by the treating practitioner or home care nurse, covering the program elements.
6. Proof of delivery and the PDAC listing: keep both in the patient’s billing file.

The LCD asks suppliers to keep these records available on request rather than sending them with the claim. Stay in contact with the wound care clinician, so the KX modifier keeps matching the patient’s condition each rental month.

Prior authorization requirements for E0373

E0373 needs prior authorization before delivery. It is on the CMS Required Prior Authorization List with the other Group 2 support surfaces, nationwide since October 21, 2019.

• Codes on the list: E0193, E0277, E0371, E0372, and E0373 all need prior authorization.
• Request: the supplier or the patient sends the request to the DME MAC, with records that support LCD L33642.
• Turnaround: the DME MAC for the patient’s jurisdiction decides an initial request within 5 business days, not to exceed 7 calendar days. CGS covers Jurisdictions B and C, and Noridian covers A and D. Expedited requests are decided within 2 business days.
• Validity: a provisional affirmation is valid for one month. Deliver within that window, or send a new request.
• Claim: a claim for E0373 without a provisional affirmation is denied.
• Commercial payers: each plan sets its own prior authorization rules, so check that payer’s policy separately.

Check the current list before each delivery. CMS updates it through Federal Register notices, most recently in July 2026.

How to submit an E0373 claim: step-by-step

E0373 claims follow the standard DME MAC workflow, with prior authorization added before delivery. Finish each step before starting the next.

1. Confirm the product: check the PDAC Product Classification List shows the model under E0373, not E0371.
2. Confirm the criteria: match the wound documentation to one of the three criteria in LCD L33642.
3. Get the standard written order: it must reach the supplier before the claim is submitted.
4. Request prior authorization: send the request to your DME MAC and wait for a provisional affirmation.
5. Deliver and document: deliver within one month of the decision and collect proof of delivery.
6. Complete the claim: bill the DME MAC on the 837P or CMS-1500 with E0373, RR, the rental month modifier, KX, and the supporting L89 code.
7. Submit and track: use your claims management software to send the claim and monitor the remittance advice.

The rental month modifiers mark where the claim falls in the rental period. KH is the first month, KI covers months two and three, and KJ covers months four through 13.

Add KX only when every LCD criterion is met and documented. Otherwise use GA with a valid Advance Beneficiary Notice, or GZ without one. Lines billed without KX, GA, or GZ are rejected as missing information.

Medicare reimbursement rate for E0373

E0373 is paid as a capped rental under the DMEPOS fee schedule. Every E0373 row in the October 2026 file carries the RR modifier and the capped rental payment category.

Find the monthly allowable for the patient’s state in the CMS DMEPOS fee schedule files. Points that affect the amount:

• Capped rental: Medicare pays monthly rental for up to 13 continuous months, then ownership passes to the patient.
• State and rural rates: the file lists separate non-rural and rural allowables for each state.
• Patient share: Part B pays 80% of the allowed amount after the deductible, leaving 20% coinsurance.
• Quarterly files: CMS publishes updated DMEPOS fee schedule files each quarter, so check the current one before you quote a figure.

Common denial reasons for E0373 and how to fix them

E0373 claims fail for predictable reasons. Tracking them through denial management workflows cuts write-offs and shortens the revenue cycle.

Understanding denial codes in medical billing helps your team triage remittance advice faster. It also shows which claims are worth appealing and which to correct and resubmit.

PDAC product verification for E0373

Only products with a written coding verification review from the PDAC contractor may be billed as E0373 or E0371. The product must also appear on the published Product Classification List. A product missing from the list for that code is denied as incorrect coding.

The coding verification lookup tool from CGS and the PDAC website are the two places to confirm a product’s classification. Use them in this order:

1. Identify the exact product: use the manufacturer name and model number, not the product category.
2. Search the Product Classification List: confirm the model is listed under E0373, not E0371 or E0372.
3. Document the check: save the search result in the patient’s billing file.
4. If the product is not listed: ask the manufacturer about its coding verification status, or switch to a listed product.
5. Re-verify new models: check every new model before you dispense it, even when it looks identical to a listed one.

How Pabau helps billing teams track E0373 rental claims

An E0373 claim depends on work done by several people before delivery. Wound notes, the written order, and the prior authorization request all have to line up. After delivery, each rental month bills as its own claim line.

Pabau, the practice management and billing platform we build, keeps notes, forms, and invoices on one patient record. Its claims management software helps track claim submission and remittance status, so your team sees which rental months have paid.

Your billers still choose the codes and assemble the documentation. Pabau makes a denied month visible early, so the correction goes out while the claim is still easy to fix.

Track every E0373 rental claim in one place

Pabau’s claims management software helps track claim submission and remittance status, so your team spots a denied rental month early. Notes and forms stay on the same patient record.

Book a demo

Conclusion

The code decision on E0373 comes down to two physical facts. The product has to replace the mattress, and it has to work without a pump. A product on top of the mattress is E0371, and one with a blower is E0372 or E0277.

After that, payment depends on work finished before delivery. That means a qualifying trunk or pelvic ulcer, a standard written order, a PDAC listing, and a provisional affirmation. Build those checks into intake, and the rental months bill cleanly.

Book a demo to see how Pabau helps your billing team follow E0373 claims from submission to remittance.

Continue your research

Need a broader grounding in DME billing rules? What is medical billing explains the end-to-end claims process that underpins every HCPCS code submission.

Trying to reduce your overall denial rate? Submitting a clean claim covers the pre-submission checks that prevent the most common DME MAC rejections.

Building a denial management workflow? Denial management in healthcare outlines how to triage, appeal, and prevent recurring claim failures across your billing team.

Frequently asked questions