Beds- Accessories and Related Items

Section: Durable Medical Equipment
Effective Date: July 01, 2019
Revised Date: May 15, 2019
Last Reviewed: May 19, 2020

Description

A hospital bed is a bed with head and leg elevation and, in some cases, height adjustment features that are used to assist individuals who require adjustment or repositioning.

Criteria

Manual/Fixed Hospital Beds with/without variable height feature

A manual hospital bed without variable height feature (also known as a fixed height hospital bed) may be considered medically necessary whenany ONE of the following criteria are met:

  • The individual’s condition requires positioning of the body, e.g., to alleviate pain, promote good body alignment, prevent contractures and/or avoid respiratory infections, in ways not feasible in an ordinary bed; or
  • The individual’s condition requires special attachments that cannot be fixed and used on an ordinary bed; or
  • The individual requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration. Pillows or wedges must have been considered.

A manual hospital bed with a variable height feature may be considered medically necessary when BOTH of thefollowing conditions are met:

  • The individual meets one of the criteria for a fixed height hospital bed; and
  • The individualrequires a bed height different than a fixed height bed to permit transfers to achair, wheelchair or standing position.

A manual hospital bed is considered non-covered when above criteria are not met.

Procedure Codes

E0250

E0251

E0255

E0256

E0290

E0291

E0292

E0293

 

Semi-Electric Hospital Beds

A semi-electric hospital bed may be considered medically necessary when ALL of the following criteria are met:

  • The individual meets all requirements for a standard hospital bed; and
  • The individual’scondition requires frequent and/or immediate change in body position (i.e., no delay can be tolerated); and
  • The individual can operate the controls himself, with the exception of spinal cord disease or injury, or brain damaged individuals.

Semi-electric beds are considered non-covered when above criteria are not met.

A semi-electric hospital bed which is provided and/or prescribed because of the absence or inability of a person caring for the individual, for aesthetic reasons, or for added convenience will be denied as non-covered. When a semi-electric hospital bed is provided but is not prescribed by the individual’s physician, the claim should be processed for the type of bed that was prescribed.

A power chair conversion feature is not covered because it is considered a convenience feature. (e.g. The Total Care Bariatric Bed is an example of an electric bed with an electric chair positioning feature.) and will therefore be denied as non-covered.

Procedure Codes

E0260 E0261 E0294 E0295

Total Electric Beds
A total electric bed is not covered; the height and adjustment feature is a convenience feature and therefore is considered non-covered.

Procedure Codes

E0265 E0266 E0296 E0297

Powered Air Flotation Beds (Low Air Loss Therapy)
Powered air flotation beds may be considered medically necessary for individuals in the third or fourth stages of decubitus ulceration and who meet all of the requirements for a manual hospital bed.

Beds under the brand name of Flexicair should be denied as non-covered for home use because they are considered institutional equipment, inappropriate for home use. The appropriateness of all other brands of powered air flotation beds for use in the home must be established on an individual consideration basis.

Power Air Flotations Beds (Low Air Loss Therapy) non-covered when the above criteria are not met.

Procedure Codes

E0193

Air-Fluidized Beds (Bead Bed)

Use of air-fluidized beds, for treatment of pressure sores may be considered medically necessary following a medical review for ALL of the following conditions:

  • The individual has a stage 3 (full thickness tissue loss) or stage 4 (deep tissue destruction) pressure sore; and
  • The individual is bedridden, or chair bound as a result of severely limited mobility; and
  • In the absence of an air-fluidized bed, theindividual would require institutionalization; and
  • The air-fluidized bed is ordered in writing by theindividual’s attending physician based upon a comprehensive assessment and evaluation of the individual after conservative treatment has been tried without success; and
  • A trained adult caregiver is available to assist the individual with activities of daily living, fluid balance, dry skin care, repositioning, recognition and management of altered mental status, dietary needs, prescribed treatments, and management and support of the air-fluidized bed system and potential problems such as leakage; and
  • A physician directs the home treatment regimen and reevaluates and recertifies the need for the air-fluidized bed on a monthly basis; and
  • All other alternative equipment has been considered and ruled out.

An Air-Fluidized Bed (Bead Bed) is considered non-covered when above the criteria are not met.

Procedure Codes

E0194

Institutional Beds
The following beds are considered institutional hospital beds and not suitable for home use and will therefore are considered non-covered:

  • Oscillating Bed; or
  • Stryker Frame; or
  • Springbase Bed; or
  • Circulating Bed; or
  • Rotational Beds; or
  • Cage Beds.

Procedure Codes

E0270

Fully Enclosed Pediatric Cribs or Pediatric Hospital Beds with 360o Side Enclosures
A fully enclosed pediatric crib (manual or electric) or a pediatric hospital bed (manual or electric) with 360o side enclosures may be considered medically necessary following a medical review. A fully enclosed pediatric crib bed not meeting individualcriteria will be denied not medically necessary.

Procedure Codes

E0300 E0328 E0329

Safety Beds
A safety bed (manual or electric) may be considered medically necessary for the primary indication of an individual’s safety in the home determined by medical review that the individual’s condition is so severe that injury may occur without use of the safety bed. Any claims for a safety bed not meeting the individual criteria will be denied not medically necessary.

Procedure Codes

E1399

Heavy Duty Hospital Beds
A heavy duty extra wide hospital bed may be considered medically necessary following a medical review when ALL of the following criteria have been met:

  • The individual has met one of the criteria for a fixed height hospital bed; and
  • The individual’s weight is more than 350 pounds but does not exceed 600 pounds.

An extra heavy-duty hospital bed may be considered medically necessary following a medical review when ALL of the following criteria have been met:

  • The individual has met one of the criteria for a fixed height hospital bed; and
  • The individual’s weight exceeds 600 pounds.

Heavy duty hospital beds are considered non-covered when the above criteria is not met.

Procedure Codes

E0301 E0302 E0303 E0304

Mattress
A mattress is considered medically necessary only when a hospital bed has been determined medically necessary. (Separate charge for replacement mattress should not be allowed when a hospital bed is rented.) If an individual’s condition requires a replacement innerspring mattress or foam rubber mattress, it may be considered medically necessary for an individual-owned hospital bed.

Procedure Codes

E0184 E0185 E0186 E0187 E0196 E0197 E0198
E0199 E0271 E0272 E0277 E0371 E0372 E0373

Bed Accessories

The following hospital bed-accessories may be considered medically necessary when a hospital bed has been determined medically necessary:

  • Bed cradles: as long as the cradles are not used as a personal comfort item.
  • Bed pans: if the individual is bed confined.
  • Bed rails: only when the rails are an integral part of a hospital bed.
  • Safety Enclosure Frame/Canopy for Use with Hospital Bed, following a medical review. any type:
  • Trapeze bars/bases: if the member is bed-confined and needs a trapeze bar to sit up because of respiratory conditions, to change body position for other medical reasons, or to get in and out of bed.
  • Built-in Weight Scale*.

*A hospital bed with a built-in scale is considered medically necessary ONLY for non-ambulatory individuals who require periodic weight measurements.

Procedure Codes

A4640

E0181

E0275

E0276

E0280

E0305

E0310

E0316

E0910

E0911

E0912

E0940


The following accessories and related items are non-covered as they are considered comfort or convenience items and therefore are considered non-covered:

  • Bed baths; or
  • Bed boards; or
  • Bed lifter; or
  • Bed lounge; or
  • Over bed tables.

Procedure Codes

A9286

E0273

E0274

E0315

 

Total payments for a rental item may not exceed its allowable purchase price, except for those items identified as life sustaining DME.

Diagnosis Codes

Not Applicable

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 5-15-2019 New policy removed statement regarding Franklin Beds

Internal Medical Policy Committee 5-19-2020 Annual Review

Disclaimer

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.