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LCD - Hospital Bed

Coverage Summary

Written Order Prior to Delivery

One or more of the below fixed height hospital bed criteria must be met:

  • The patient has a medical condition which requires positioning not feasible in an ordinary bed. (Elevation less than 30 degrees does not usually require use of a hospital bed), or;
  • The patient requires positioning not feasible in an ordinary bed to alleviate pain, or;
  • The patient requires the head of the bed to be elevated more than 30 degrees due to CHF, chronic pulmonary disease, or problems with aspiration, or;
  • The patient requires traction equipment which can only be attached to a hospital bed (traction equipment, not trapeze)

Semi Electric Hospital Bed:

  • Must meet coverage criteria for fixed height hospital bed, and; patient requires frequent changes in body position and/or has an immediate need for change in body position.

Order Requirements

  • DME Order Form
  • Dr. must be PECOS registered for all Medicare orders.

  1. Patient's Name
  2. Detailed description of specific equipment being ordered (Semi Electric Bed, Full Electric Bed, Fixed Height Bed, Heavy Duty Bed)
  3. Qty to be dispensed
  4. Ordering Physician’s NPI
  5. Ordering physician’s legible signature (personally written or electronically signed by the physician, stamps are not accepted by insurance.)
  6. Ordering physician’s legible signature date (personally written or electronically signed by the physician, stamps are not accepted by insurance.)
  7. Start date of the order – if different than signature date.

Coverage Detail

Patient MUST meet one or more of below (1-4) fixed height hospital bed criteria:

  1. The patient has a medical condition which requires positioning not feasible in an ordinary bed. (Elevation less than 30 degrees does not usually require use of a hospital bed). OR
  2. The patient requires positioning not feasible in an ordinary bed to alleviate pain. OR
  3. The patient requires the head of the bed to be elevated more than 30 degrees due to CHF, chronic pulmonary disease, or problems with aspiration OR
  4. The patient requires traction equipment which can only be attached to a hospital bed (traction equipment, not trapeze)

Additional, to qualify for Semi-Electric bed:

  1. Patient requires frequent changes in body position and/or has an immediate need for a change in body position. Reason for frequent or immediate body changes must be documented.

Note:

  • If hospital bed is ordered due to pain, treatment of the pain needs to be documented (examples include: specific reason for pain, pain scale, frequency of pain, location of pain).


*A variable height hospital bed (E0255, E0256, E0292, and E0293) is covered if the beneficiary meets one of the criteria for a fixed height hospital bed and requires a bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair or standing position.

*A semi-electric hospital bed (E0260, E0261, E0294, E0295, and E0329) is covered if the beneficiary meets one of the criteria for a fixed height bed and requires frequent changes in body position and/or has an immediate need for a change in body position.

*A heavy duty extra wide hospital bed (E0301, E0303) is covered if the beneficiary meets one of the criteria for a fixed height hospital bed and the beneficiary's weight is more than 350 pounds, but does not exceed 600 pounds.

*An extra heavy-duty hospital bed (E0302, E0304) is covered if the beneficiary meets one of the criteria for a hospital bed and the beneficiary's weight exceeds 600 pounds.

*A total electric hospital bed (E0265, E0266, E0296, and E0297) is not covered; the height adjustment feature is a convenience feature. Total electric beds will be denied as not reasonable and necessary.