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See a sample rate comparisonHCPCS E0196 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Gel pressure mattress
| Key Fact | Detail |
|---|---|
| Service Type | Durable Medical Equipment Pressure Mattresses, Pads, and Other Supplies |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for E0196 |
National average reimbursement for HCPCS E0196 by major payers:
$116.43
$164.11
$191.06
$449.98
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HCPCS E0196
5 of 25 sample ratesHigher to lower in this preview
Emory University Hospital
Emory University
$617.96Published rateTattnall Hospital Company, LLC, Optim Medical Center - Tattnall
$162.38Published rateEmanuel County Hospital Authority, Emanuel Medical Center
$132.25Published rateMichael Koch
Chestatee Pathology Associates PC
$129.22Published rateMichael Koch
Chestatee Pathology Associates PC
$18.28Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS E0196 vs. Other Pressure Mattresses, Pads, and Other Supplies Codes
The HCPCS E0196 code is part of the Durable Medical Equipment services used for Pressure Mattresses, Pads, and Other Supplies. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS E0196 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| E0194-HCPCS | High | Air fluidized bed |
| E0196-HCPCS | Low | Gel pressure mattress |
| E0197-HCPCS | Low | Air pressure pad for mattress, standard mattress length and width |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS E0196. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the E0196 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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