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.
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 when any ONE of the following criteria are met:
A manual hospital bed with a variable height feature may be considered medically necessary when BOTH of the following conditions are met:
A manual hospital bed will deny as non-covered when above criteria are not met.
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’s condition 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 will deny as 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.
Total Electric Beds
A total electric bed is not covered; the height and adjustment feature is a convenience feature and therefore will deny as non-covered.
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) will deny a non-covered when the above criteria are not met.
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:
An Air-Fluidized Bed (Bead Bed) will deny as non-covered when above the criteria are not met.
The following beds are considered institutional hospital beds and not suitable for home use and will therefore deny as non-covered:
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 patient criteria will be denied not medically necessary.
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 patient criteria will be denied not medically necessary.
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:
An extra heavy duty hospital bed may be considered medically necessary following a medical review when ALL of the following criteria have been met:
Heavy duty hospital beds will deny as non-covered when the above criteria is not met.
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 will be considered medically necessary for an individual-owned hospital bed.
The following hospital bed-accessories may be considered medically necessary when a hospital bed has been determined medically necessary:
*A hospital bed with a built-in scale is considered medically necessary ONLY for non-ambulatory individuals who require periodic weight measurements.
The following accessories and related items are non-covered as they are considered comfort or convenience items and therefore will deny as non-covered:
Total payments for a rental item may not exceed its allowable purchase price, except for those items identified as life sustaining DME.
The use of beds, accessories and related items is typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances, including, but not limited to, the presence of a co-morbid condition that would require monitoring in a more controlled environment such as the inpatient setting.