L89.204: Pressure ulcer of unspecified hip, stage 4
L89.204, pressure ulcer of unspecified hip, stage 4, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 11 HCPCS Level II codes, including E0194 (Air fluidized bed), E0193 (Powered air flotation bed (low air loss therapy)), E0373 (Nonpowered advanced pressure reducing mattress). 7 of these codes have a 2026 DMEPOS fee schedule amount; E0194 pays $3,856.78 to $4,884.31 (RR) depending on the state. The articles come from 2 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with L89.204 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| E0194 | Air fluidized bed | Special coverage instructions apply | $3,856.78–$4,884.31 (RR) | 1 |
| E0193 | Powered air flotation bed (low air loss therapy) | Carrier judgment | $837.96–$1,189.47 (RR) | 1 |
| E0373 | Nonpowered advanced pressure reducing mattress | Carrier judgment | $185.56–$576.49 (RR) | 1 |
| E0277 | Powered pressure-reducing air mattress | Special coverage instructions apply | $185.56–$563.59 (RR) | 1 |
| E0372 | Powered air overlay for mattress, standard mattress length and width | Carrier judgment | $185.56–$519.97 (RR) | 1 |
| E0371 | Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width | Carrier judgment | $185.56–$451.50 (RR) | 1 |
| E0181 | Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty | Special coverage instructions apply | $17.94–$36.69 (RR) | 1 |
| E1399 | Durable medical equipment, miscellaneous | Carrier judgment | — | 1 |
| G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | Carrier judgment | — | 1 |
| G0281 | Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care | Carrier judgment | — | 1 |
| G0329 | Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care | Carrier judgment | — | 1 |
Medicare policy articles listing L89.204
- A52468: Pressure Reducing Support Surfaces - Group 3- Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 1 Level II codes). LCD with the same title: L33692
- A52490: Pressure Reducing Support Surfaces - Group 2 - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 7 Level II codes). LCD with the same title: L33642
- A53064: Billing and Coding: Outpatient Occupational Therapy (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34427
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other L89 diagnoses (Pressure ulcer)
- L89.203 — Pressure ulcer of unspecified hip, stage 3
- L89.206 — Pressure-induced deep tissue damage of unspecified hip
- L89.210 — Pressure ulcer of right hip, unstageable
- L89.211 — Pressure ulcer of right hip, stage 1
- L89.212 — Pressure ulcer of right hip, stage 2
- L89.213 — Pressure ulcer of right hip, stage 3
- L89.214 — Pressure ulcer of right hip, stage 4
- L89.216 — Pressure-induced deep tissue damage of right hip
- L89.220 — Pressure ulcer of left hip, unstageable
- L89.221 — Pressure ulcer of left hip, stage 1
- L89.222 — Pressure ulcer of left hip, stage 2
- L89.223 — Pressure ulcer of left hip, stage 3
- L89.224 — Pressure ulcer of left hip, stage 4
- L89.226 — Pressure-induced deep tissue damage of left hip
- L89.006 — Pressure-induced deep tissue damage of unspecified elbow
- L89.010 — Pressure ulcer of right elbow, unstageable
- L89.011 — Pressure ulcer of right elbow, stage 1
- L89.012 — Pressure ulcer of right elbow, stage 2
- L89.013 — Pressure ulcer of right elbow, stage 3
- L89.014 — Pressure ulcer of right elbow, stage 4
- L89.016 — Pressure-induced deep tissue damage of right elbow
- L89.020 — Pressure ulcer of left elbow, unstageable
- L89.021 — Pressure ulcer of left elbow, stage 1
- L89.022 — Pressure ulcer of left elbow, stage 2
- L89.023 — Pressure ulcer of left elbow, stage 3
- L89.024 — Pressure ulcer of left elbow, stage 4
- L89.026 — Pressure-induced deep tissue damage of left elbow
- L89.103 — Pressure ulcer of unspecified part of back, stage 3
- L89.104 — Pressure ulcer of unspecified part of back, stage 4
- L89.106 — Pressure-induced deep tissue damage of unspecified part of back
Frequently asked questions
Does Medicare cover L89.204 (Pressure ulcer of unspecified hip, stage 4)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list L89.204 as a covered diagnosis for 11 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 L89.204?
The Level II codes from the policies most specific to this diagnosis are E0194 (Air fluidized bed, 1 article); E0193 (Powered air flotation bed (low air loss therapy), 1 article); E0373 (Nonpowered advanced pressure reducing mattress, 1 article); E0277 (Powered pressure-reducing air mattress, 1 article); E0372 (Powered air overlay for mattress, standard mattress length…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with L89.204?
Under the 2026 DMEPOS fee schedule (non-rural state fees): E0194 $3,856.78 to $4,884.31 (RR); E0193 $837.96 to $1,189.47 (RR); E0373 $185.56 to $576.49 (RR); E0277 $185.56 to $563.59 (RR). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list L89.204?
A52468 (Pressure Reducing Support Surfaces - Group 3- Policy Article); A52490 (Pressure Reducing Support Surfaces - Group 2 - Policy Article); A53064 (Billing and Coding: Outpatient Occupational Therapy).
What is ICD-10-CM code L89.204?
L89.204 is the ICD-10-CM code for pressure ulcer of unspecified hip, stage 4, in category L89 (Pressure ulcer), chapter 12: Diseases of the skin and subcutaneous tissue.
Next steps
- Run a reimbursement report for a device billed under E0194
- Watch E0194 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for E0194
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 12: Diseases of the skin and subcutaneous tissue · All diagnoses · HCPCS lookup