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Hospital Beds and Accessories
05.00.56l

Policy

MEDICALLY NECESSARY

FIXED-HEIGHT HOSPITAL BEDS
A fixed-height hospital bed is considered medically necessary and, therefore, covered when the individual meets one or more of the following medical necessity criteria:
  • The individual has a medical condition that requires positioning of the body in ways that are not feasible in an ordinary bed. The elevation of the head/upper body of less than 30 degrees does not usually require the use of a hospital bed.
  • The individual requires head elevation of more than 30 degrees most of the time due to congestive heart failure, problems with aspiration, or chronic pulmonary disease.
  • The individual has a medical condition that requires positioning of the body in ways that are not feasible in an ordinary bed to alleviate pain.
  • The individual requires traction equipment that can only be attached to a hospital bed.
VARIABLE-HEIGHT HOSPITAL BEDS
A variable-height hospital bed is considered medically necessary and, therefore, covered for individuals with severely debilitating diseases and conditions (including, but not limited to: severe arthritis and other injuries to the lower extremities, severe cardiac conditions, spinal cord injuries, amyotrophic lateral sclerosis [ALS], and multiple sclerosis) when both of the following criteria are met:
  • The individual meets one or more of the medical necessity criteria for a fixed-height hospital bed.
  • The individual requires a bed height that cannot be attained with a fixed-height hospital bed and that allows the individual the ability to transfer to a chair, wheelchair, standing position or if the variable-height feature is required to assist the individual to ambulate.
SEMI-ELECTRIC HOSPITAL BEDS
A semi-electric hospital bed is considered medically necessary and, therefore, covered when the individual meets one or more of the medical necessity criteria for a fixed-height hospital bed and both of the following criteria:
  • The individual's condition requires the body position to be changed frequently and/or immediately when necessary (i.e., no delay can be tolerated).
  • The individual is able to operate the controls to make the adjustments. Exceptions to this requirement can be made in cases of spinal cord injury or brain injury.
HEAVY-DUTY, EXTRA-WIDE HOSPITAL BEDS
A heavy-duty, extra-wide hospital bed is considered medically necessary and, therefore, covered when the individual meets one or more of the medical necessity criteria for a fixed-height hospital bed and when the individual's weight exceeds 350 pounds but is less than 600 pounds.

EXTRA-HEAVY-DUTY HOSPITAL BEDS
An extra-heavy-duty hospital bed is considered medically necessary and, therefore, covered when the individual meets one or more of the medical necessity criteria for a fixed-height hospital bed and when the individual's weight exceeds 600 pounds.

PEDIATRIC HOSPITAL BEDS
A pediatric hospital bed is considered medically necessary and, therefore, covered when the individual meets all of the medical necessity criteria for one of the hospital beds specified above.​

​HOSPITAL BED ACCESSORIES
The following hospital bed accessories are considered medically necessary and, therefore, covered when the individual meets the medical necessity criteria for the specified bed, in addition to the specific criteria indicated below:
  • Bed cradle: When the individual has a medical condition that requires the prevention of contact with bed coverings (e.g., burns, diabetic ulcers, gout)
  • Trapeze equipment: When the individual requires this device to do any one of the following:
    • Sit up because of a respiratory condition
    • Change body position for other medical reasons
    • Get in or out of bed
  • Heavy-duty trapeze equipment: When the individual meets both of the following criteria:
    • The individual meets the criteria for regular trapeze equipment
    • The individual's weight exceeds 250 pounds
  • Side rails: When bed rails are required due to the individual's condition and the rails are an integral part of or an accessory to the hospital bed.
  • Replacement innerspring mattress or foam rubber mattress: When an individual's medical condition requires a replacement innerspring mattress or foam rubber mattress and the member meets all of the criteria for replacement of durable medical equipment (DME) as listed in the Repair and Replacement of DME policy, the replacement mattress will be covered for a member-owned hospital bed.
CONCURRENT RENTAL OR OWNERSHIP OF A PRESSURE-REDUCING SUPPORT MATTRESS

When an individual owns or rents a medically necessary pressure-reducing support mattress and a hospital bed becomes medically necessary, a hospital bed that includes a mattress will not be covered.

In situations where the pressure-reducing support mattress is incompatible with the hospital bed (e.g., does not fit the hospital bed), the concurrent rental or ownership of a pressure-reducing support mattress statement of noncoverage does not apply.

NOT MEDICALLY NECESSARY
 
If the individual does not meet any of the above coverage criteria for any type of hospital bed, it will be considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support their use in the treatment of illness or injury.​

BENEFIT EXCLUSIONS

HOSPITAL BEDS WITH ELECTRIC HEIGHT ADJUSTMENT FEATURES
Total electric hospital beds and semi-electric hospital beds with electric height adjustment (e.g., Hannah Secure Sleep System with electric height adjustment) are considered a benefit exclusion and, therefore, not covered because the electric height adjustment feature is considered a convenience feature. Therefore it is not eligible for reimbursement consideration.

INSTITUTIONAL HOSPITAL BEDS
An institutional hospital bed is considered a benefit exclusion and, therefore, not covered because it is deemed inappropriate for home use. These beds include oscillating beds, circulating beds, and Stryker frame beds. Therefore, they are not eligible for reimbursement consideration.

HOSPITAL BED ACCESSORIES
The following hospital bed accessories are considered benefit exclusions and, therefore, not covered because use of these devices is not primarily medical in nature. Therefore, they are not eligible for reimbursement consideration:​
  • Bed board (a device placed under a mattress to make the mattress firmer)
  • Overbed table
SAFETY ENCLOSURES
  • Safety enclosures (nylon netting that encloses the top and sides of a hospital bed) and totally enclosed beds (e.g., SleepSafe bed with tall safety rail and closed top, Pedicraft canopy enclosed bed) are considered benefit exclusions and, therefore, not covered because use of these devices is not primarily medical in nature. Additionally, these devices have safety concerns associated with them.
Commercially available beds that can be purchased by the general public are not considered hospital beds. These beds and any related accessories are considered a benefit exclusion and, therefore, not covered because they are not primarily medical in nature. Therefore, ​commercially available beds are not eligible for reimbursement consideration.

​COLUMN I/COLUMN II REIMBURSEMENT EDITS

The reimbursement for the item(s) represented by the code(s) in column II are included in the reimbursement for the item represented by the code in column I.

Column I
Column II
E0250E0271, E0272, E0305, E0310
E0251E0305, E0310
E0255E0271, E0272, E0305, E0310
E0256E0305, E0310
E0260E0271, E0272, E0305, E0310
E0261E0305, E0310
E0265E0271, E0272, E0305, E0310
E0266E0305, E0310
E0290E0271, E0272
E0292E0271, E0272
E0294E0271, E0272
E0296E0271, E0272
E0301E0305, E0310
E0302E0305, E0310
E0303E0271, E0272, E0305, E0310
E0304E0271, E0272, E0305, E0310
E0328E0271, E0272, E0305, E0310
E0329E0271, E0272, E0305, E0310

REQUIRED DOCUMENTATION

The Company may conduct reviews and audits of services to our members regardless of the participation status of the provider. Medical record documentation must be maintained on file to reflect the medical necessity of the care and services provided. These medical records may include but are not limited to: records from the professional provider’s office, hospital, nursing home, home health agencies, therapies, and test reports.

STANDARD WRITTEN ORDER REQUIREMENTS
Before submitting a claim to the Company, the supplier must have on file a timely, appropriate, and complete standard written order for each item billed that is signed and dated by the professional provider who is treating the member. Requesting a provider to sign a retrospective standard written order at the time of an audit or after an audit for submission as an original standard written order, reorder, or updated order will not satisfy the requirement to maintain a timely professional provider order on file. 

PROOF OF DELIVERY REQUIREMENTS
Medical record documentation must include a contemporaneously prepared delivery confirmation or member’s receipt of supplies and equipment. The medical record documentation must include a copy of delivery confirmation if delivered by a commercial carrier and a signed copy of delivery confirmation by member/caregiver if delivered by the DME supplier/provider. All documentation is to be prepared contemporaneous with delivery and be available to the Company upon request.

CONSUMABLE SUPPLIES (WHEN APPLICABLE)
The DME supplier must monitor the quantity of accessories and supplies an individual is actually using. Contacting the individual regarding replenishment of supplies should not be done earlier than approximately 7 days prior to the delivery/shipping date. Dated documentation of this contact with the individual is required in the individual’s medical record. Delivery of the supplies should not be done earlier than approximately 5 days before the individual would exhaust their on-hand supply.

For specified DME items, documentation of a face-to-face encounter, between the treating professional provider and the individual meeting the above requirements, including an assessment of the individual’s clinical condition supporting the need for the prescribed DME item(s), must be provided to and kept on file by the DME supplier.

If required documentation is not available on file to support a claim at the time of an audit or record request, the DME supplier may be required to reimburse the Company for overpayments.​​

Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, hospital beds and hospital bed accessories are covered under the medical benefits of the Company’s products when the medical necessity criteria listed in the medical policy are met.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

The FDA has approved several hospital beds and considers manual adjustable hospital beds to be Class I devices and alternating current (AC)–​powered adjustable hospital beds to be Class II devices, both of which are exempt from premarket notification procedures.

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 to alleviate pain, prevent contractures, prevent respiratory infections, and allow individuals to transfer to and from the bed with increased independence.

There are several categories of hospital beds, including, but not limited to, the following:
  • Fixed-height hospital bed: Has manual head and leg elevation adjustments but no height adjustment.
  • Variable-height hospital bed: Has manual head and leg elevation adjustments and manual height adjustment.
  • Semi-electric hospital bed: Has electric head and leg elevation adjustments and manual height adjustment.
  • Heavy-duty, extra-wide hospital bed: Can support an individual whose weight is between 350 and 600 pounds and is available in semi-electric or total-electric models.
  • Extra-heavy-duty hospital bed: Can support an individual whose weight exceeds 600 pounds and is available in semi-electric or total-electric models.
  • Total-electric hospital bed: Has electric head and leg elevation adjustments and electric height adjustment.
The US Food and Drug Administration (FDA) considers manual adjustable hospital beds to be Class I devices, and alternating current (AC)–​powered adjustable hospital beds to be Class II devices, both of which are exempt from premarket notification procedures.

Hospital bed accessories are additions to a bed that are not provided as part of the original bed. Accessories that may be needed for the essential functioning of the hospital bed in relation to the individual's condition include trapeze bars, bed cradles, or side rails.

References

Centers for Medicare & Medicaid Services (CMS). CMS Internet Only Manual Publication. Pub 100-03: Medicare National Coverage Determinations. Part 4 -- Chapter 1: Hospital Beds. §280.17. [CMS Web site]. 02/16/23​. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ncd103c1_Part4.pdf. Accessed March 2, 2023.

​

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). 280.7: Hospital beds. [CMS Web site]. 05/01/89. Available at: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=227&ncdver=1&keywordtype=starts&keyword=hospital bed&bc=0. Accessed March 2, 2023​.


Noridian Healthcare Services, LLC. Local Coverage Article. A52508: Hospital Beds and Accessories - Policy Article. [Noridian Web site]. Original: 10/01/15. (Revised: 01/01/20). Available at: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33820. Accessed March 2, 2023.

Noridian Healthcare Services, LLC. Local Coverage Determination (LCD).L33820: Hospital Beds and Accessories. [Noridian Web site]. Original: 10/01/15. (Revised: 01/01/20). Available at: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33820. Accessed March 2, 2023.

US Food and Drug Administration (FDA). FDA Preliminary Public Health Notification. Vail products enclosed bed systems. [FDA Web site]. Original: 03/25/05. (Revised: 12/04/07). Available at: https://wayback.archive-it.org/7993/20170111190525/http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm062025.htm. Accessed March 2, 2023.​

Coding

CPT Procedure Code Number(s)
N/A
ICD - 10 Procedure Code Number(s)
N/A
ICD - 10 Diagnosis Code Number(s)
N/A
HCPCS Level II Code Number(s)
MEDICALLY NECESSARY

THE FOLLOWING CODES ARE USED TO REPRESENT FIXED HEIGHT HOSPITAL BEDS:

E0250 Hospital bed, fixed height, with any type side rails, with mattress

E0251 Hospital bed, fixed height, with any type side rails, without mattress

E0290 Hospital bed, fixed height, without side rails, with mattress

E0291 Hospital bed, fixed height, without side rails, without mattress

E0328 Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 in above the spring, includes mattress


THE FOLLOWING CODES ARE USED TO REPRESENT VARIABLE HEIGHT HOSPITAL BEDS:

E0255 Hospital bed, variable height, hi-lo, with any type side rails, with mattress

E0256 Hospital bed, variable height, hi-lo, with any type side rails, without mattress

E0292 Hospital bed, variable height, hi-lo, without side rails, with mattress

E0293 Hospital bed, variable height, hi-lo, without side rails, without mattress


THE FOLLOWING CODES ARE USED TO REPRESENT SEMI-ELECTRIC HOSPITAL BEDS:

E0260 Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress

E0261 Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress

E0294 Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress

E0295 Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress

E0329 Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 in above the spring, includes mattress


THE FOLLOWING CODES ARE USED TO REPRESENT HEAVY DUTY HOSPITAL BEDS:

E0301 Hospital bed, heavy-duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress

E0303 Hospital bed, heavy-duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress


THE FOLLOWING CODES ARE USED TO REPRESENT EXTRA HEAVY DUTY HOSPITAL BEDS:

E0302 Hospital bed, extra heavy-duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress

E0304 Hospital bed, extra heavy-duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress


THE FOLLOWING CODES ARE USED TO REPRESENT HOSPITAL BED ACCESSORIES:

E0280 Bed cradle, any type

E0305 Bedside rails, half-length

E0310 Bedside rails, full-length

E0910 Trapeze bars, also known as Patient Helper, attached to bed, with grab bar

E0911 Trapeze bar, heavy-duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar

E0912 Trapeze bar, heavy-duty, for patient weight capacity greater than 250 pounds, freestanding, complete with grab bar

E0940 Trapeze bar, freestanding, complete with grab bar


THE FOLLOWING CODES ARE COVERED FOR REPLACEMENT OF A MEMBER-OWNED HOSPITAL BED:

E0271 Mattress, innerspring

E0272 Mattress, foam rubber


BENEFIT EXCLUSIONS

E0265 Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress

E0266 Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, without mattress

E0270 Hospital bed, institutional type includes: oscillating, circulating and Stryker frame, with mattress

E0273 Bed board

E0274 Over-bed table

E0296 Hospital bed, total electric (head, foot, and height adjustments), without side rails, with mattress

E0297 Hospital bed, total electric (head, foot, and height adjustments), without side rails, without mattress

E0315 Bed accessory: board, table, or support device, any type

E0316 Safety enclosure frame/canopy for use with hospital bed, any type


THE FOLLOWING CODE IS USED TO REPRESENT SEMI-ELECTRIC HOSPITAL BEDS WITH ELECTRIC HEIGHT ADJUSTMENT (EG. HANNAH SECURE SLEEP SYSTEM WITH ELECTRIC HEIGHT ADJUSTMENT) AND TOTALLY ENCLOSED BEDS (EG. SleepSafe bed with tall safety rail and closed top, Pedicraft enclosed canopy bed)

E1399 Durable medical equipment, miscellaneous
Revenue Code Number(s)
N/A


Coding and Billing Requirements

Policy History

4/17/2023
4/17/2023
05.00.56
Medical Policy Bulletin
Commercial
No
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Independence Blue Cross is a subsidiary of Independence Health Group, Inc. — independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.