More than 360 others were injured and many were still believed to be buried under rubble with over 4,300 rescuers deployed to find them, BBC quoted the department officials as saying.
Health officials said the toll could rise as some of the injured were in critical conditions.
The powerful earthquake hit 10 km southeast of Norcia at 3.36 a.m., on Wednesday.
According to the department, majority of the deaths occurred in Rieti province with 190 victims and 57 in neighbouring Ascoli Piceno province, the BBC reported.
Rescuers said they had pulled five bodies from the ruins of the Hotel Roma in the historic town of Amatrice. Officials said about 35 people were staying at the hotel and most had managed to get out.
About 10 people were still unaccounted for, a local fire official said.
Late on Wednesday there were cheers in the village of Pescara del Tronto when a young girl was pulled alive from the rubble after being trapped for 17 hours.
Almost all the houses there had collapsed, the BBC reported citing local officials as saying.
Hardest hit were the small towns and villages in the mountainous area where the regions of Umbria, Lazio and Le Marche meet.
More than 1,000 people have been displaced by the quake and no residents were be allowed to sleep in the devastated town of Amatrice on Wednesday night.
The mayor of Amatrice said three-quarters of the town had been destroyed and no building was safe for habitation, the BBC said.
Many of those affected were on holiday in the region. Some were in Amatrice for a festival to celebrate a famous local speciality - amatriciana bacon and tomato sauce.