Hospital Beds

Revised: April 17,

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Overview

Hospital beds are used for positioning patients.

Eligible Providers

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Medical suppliers

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Pharmacies

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Home health agencies

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Indian Health Services

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Federally qualified health centers

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Rural health clinics

TPL and Medicare

Providers must meet any provider criteria, including accreditation, for third-party insurance or for Medicare to assist members for whom Minnesota Health Care Programs (MHCP) is not the primary payer.

MHCP quantity limits and thresholds apply to all members unless only Medicare coinsurance or deductible is requested.

Eligible Members

Hospital beds are covered for eligible MHCP members who meet the medical necessity criteria.

Covered Services

Fixed-height manual hospital beds

Codes: E, E, E, E
Covered for members with one of the following:

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A medical condition that requires positioning of the body not feasible in an ordinary bed, where pillows or wedges do not meet the member&#;s needs

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Protection needed from serious injury not feasible in an ordinary bed, where pillows or wedges do not meet the member&#;s needs.

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A medical condition that requires special attachments, such as traction equipment, that cannot be fixed and used on an ordinary bed

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A medical condition that requires the head of the bed to be elevated more than 30 degrees, where pillows or wedges do not meet the member&#;s needs

Variable-height manual hospital beds

Codes: E, E, E, E
Covered for members who meet criteria for a fixed-height manual hospital bed and require one of the following criteria:

·

A bed height different than a fixed-height hospital bed to permit transfers in or out of the bed

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A change of bed height to enable caregivers to assist with member care

Semi-electric hospital beds

Codes: E, E, E, E
Covered for members who meet criteria for a fixed-height manual hospital bed and require one of the following criteria:

·

Frequent changes in body position to alleviate pain or address a medical condition

·

Immediate changes in body position to alleviate pain or address a medical condition

Total electric hospital beds

Codes: E, E, E, E
Covered for members who meet criteria for a hospital bed and both of the following criteria:

·

Require a change of bed height at least once per day to allow a caregiver to assist with the member&#;s care

·

The caregiver is unable to change the bed height manually, but is able to assist with all necessary cares in bed

Bariatric, extra-heavy duty, extra wide hospital beds

Codes: E-E
Covered for members who meet criteria for the type of hospital bed requested (manual, semi-electric, total electric) and whose weight is within the capacity limits of the requested bed.

Coverage may be considered for members with daily seizure activity, uncontrolled movement disorder, or a medically necessary condition putting the member at significant risk for injury in a standard bed. Requests for a manual, semi-electric, or total electric bed must meet the criteria for the type of hospital bed requested.

Pediatric hospital beds

Codes: E-E
Covered for members who meet criteria for a manual, semi-electric or total electric hospital bed and who have medical needs best met by a pediatric-sized bed with footboard and side rails up to 24 inches above the spring. The bed must be reasonably expected to meet the member&#;s needs for at least five years.

Enclosed beds

Codes: E (enclosure), E (hospital-grade enclosed crib), E (Enclosed bed manufactured as a unit)

Enclosed beds are considered medically necessary and the least costly alternative only in the most extreme conditions due to the restrictive nature of the beds and the confinement they entail. Enclosed beds may be fully or partially enclosed.

Based on advice from medical consultants, MHCP considers an enclosed bed medically necessary when the member is cognitively impaired and mobile if their unrestricted mobility demonstrates significant risk for serious injury, not just a possibility of injury. Even then, it must be shown that other, less costly methods have been attempted and have failed to effectively address the problem.

Generally, such confinement is not medically necessary nor the least costly way of managing seizures or behaviors such as head banging, rocking, or similar. Issues of sensory deprivation and the potential for overuse must also be addressed in this process.

Coverage will be considered for members who have documented evidence of unsafe mobility (climbing out of bed and moving round the home, not just standing at the side of the bed).

The member must meet the following criteria:

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Diagnosis of one of the following:

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Brain injury

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Moderate to severe cerebral palsy

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Seizure disorder with daily seizure activity

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Developmental disability

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Severe behavioral disorder

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Documentation of a specific risk from unrestricted mobility including:

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Tonic-clonic type seizures

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Uncontrolled perpetual movement related to diagnosis

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Self-injurious behavior

Documentation must show that you have tried or considered, and rejected less costly alternatives, including any of the following (not all-inclusive):

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Padding around a regular or hospital bed

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Placing the mattress on the floor

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Medications to address seizures or behaviors

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Behavior modification strategies

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Helmets for head banging

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Removing safety hazards from the member&#;s bedroom and using a child protection device on the door knob

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Baby monitors to listen to the member&#;s activity

MHCP believes there is no clear-cut medical justification for enclosed beds. The real need is to proactively address with intervention the underlying medical or behavioral issues that give rise to the risk of harm.

Enclosed bed options and accessories
Enclosed bed options and accessories are covered if they are medically necessary and address a specific medical need of the member. All requested accessories require an evaluation from an occupational therapist or a behavioral therapist that works directly with the member. The following list of options and accessories is not all-inclusive; many additional options and accessories may be covered if medically necessary.

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High-side door system: Covered for members that have documented of being able to stand taller than or climb over the standard size side door system.

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Gel-infused mattress: Covered for members that have a documented diagnosis of dysautonomia or a condition that is exacerbated by increased temperatures.

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Padding on inside of bed: Covered for members that have a documented diagnosis of seizures or uncontrolled movement disorders.

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Semi-electric or electric articulation: Covered for members that have a documented medical reason why the caregiver is unable to use a manually adjustable bed.

Replacement mattress or bed rails

Codes: E-E (mattress), E. E (bed rails)
Covered when used with a patient-owned hospital bed.

When replacing a mattress on a patient-owned heavy-duty or bariatric bed, include &#;bariatric mattress for patient-owned bariatric bed&#; and the authorization number or purchase date for the bed, if known, in the Claim Notes field on the Claim Information tab or in the line item Notes field on the Services tab in MN&#;ITS. For X12 batch submission, refer to the Minnesota Uniform Companion Guides. Use modifiers NU and U3.

Typically Noncovered Services

Some services are typically not covered but may be covered in certain situations. Refer to criteria under Typically Noncovered Services in the Equipment and Supplies section of the MHCP Provider Manual.

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Beds, which are typically sold as furniture, including adjustable beds that are not manufactured as durable medical equipment

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Orthopedic mattresses

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Waterbeds

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Oscillating and lounge beds

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Bed tables and other bed accessories

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Bedding or linens, including hypoallergenic bedding

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Heat and massage pads

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Enclosed beds for members with one-on-one caregiver supervision 24 hours per day

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The following accessories for enclosed beds:

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Technology hub

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Extra windows

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Mattress protector

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Vibration pad

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Dual multi-side doors

Refer to information under the Noncovered Services heading in the Billing the Member (Recipient) section of the MHCP Provider Manual to review the conditions required to bill the member.

Authorization

Submit authorization request and required documentation to the Authorization Medical Review Agent.

Hospital Bed Authorization and Documentation Requirements

Item

Authorization Requirements

Documentation Requirements

Manual hospital beds

Not required for rental or purchase

Documentation in the provider&#;s files must establish medical necessity as described under Covered Services in the Fixed-height manual hospital beds subsection.

Semi-electric hospital beds

Required after three months rental and for all purchases

Authorization requests must document the medical condition that requires a hospital bed, and the frequency of severity of symptoms that require repositioning. Include a description of the member&#;s or caregiver&#;s judgment and ability to operate the bed.

Total electric hospital beds

Always required for purchase or rental

Authorization requests must document the medical condition that requires a hospital bed, and the reason that changes in bed height are required. Include documentation that demonstrates that the caregiver is unable to change the bed height manually, but is able to assist with needed cares and transfers.

Bariatric/heavy-duty hospital beds

Required

Authorization requests must document the medical condition that requires a hospital bed, and the weight of the member that justifies a heavy-duty hospital bed.

Authorization requests for a member with daily seizures, uncontrolled movement disorder, or a medically necessary condition must include the history and nature of the seizure, movement disorder, or condition, and document the significant risk of injury in a standard hospital bed.

Pediatric hospital beds

Required

Authorization requests must document the medical condition that requires a manual, semi-electric or total electric hospital bed, as well as the medical condition that prevents the use of a standard size hospital bed. Include documentation of the member&#;s current age, height and weight and expected growth.

Enclosed beds

Required

Complete both the Enclosed Medical Bed Authorization (DHS-) (PDF) and the Minnesota Health Care Programs Authorization Form (DHS-) (PDF). Submit completed forms to Authorization Medical Review Agent as instructed on authorization forms.

Documentation must include a diagnosis that is directly linked to the need for the enclosed bed, a complete description of the member&#;s mobility, documentation of the specific risk from unrestricted bedtime mobility, the member&#;s history of injuries related to bedtime mobility, all less costly and less intrusive alternatives tried or considered and why they were rejected, and all other information requested on the authorization form.

List all accessories and options that are not included with a standard enclosed bed, as determined by the manufacturer, on separate lines on the authorization request. List each item by HCPCS code, appropriate modifier, quantity, with the charge and medical necessity documentation for all nonstandard items.

Billing

·

Providers are responsible to

coordinate services

. Refer to the

Billing Policy Overview

section of

Provider Basics

for general billing information.

·

Codes E, E, E, E, E, E, E, and E include the bed, bed rails and mattress. Do not bill rails (E, E) or mattress (E, E) within 180 days of billing these codes.

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Codes E, E, E, E, E, and E include the bed and bed rails. Do not bill rails (E, E) within 180 days of bill these codes.

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Codes E, E, E and E include the bed and mattress. Do not bill mattress (E, E) within 180 days of billing these codes.

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If the member has

Medicare

, MHCP will pay only the deductible and coinsurance on any item for which Medicare made payment, regardless of any MHCP authorization.

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If the member has Medicare, any items for which Medicare denies payment must meet MHCP coverage and authorization requirements.

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Shipping, delivery, and set-up costs are included in the MHCP maximum allowable payment and may not be separately billed to MHCP or the member.

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Hospital beds are expected to serve the member for at least five years. If a device is stolen or damaged beyond repair, a replacement device may be covered with authorization.

·

Refer to

Non-Mobility Equipment Repairs

for billing requirements for repairs to hospital beds.

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While recovering from an illness or injury, or when receiving long-term medical care at home, a hospital bed is a versatile alternative to a standard bed. Most hospital beds are designed with some degree of mattress-positioning adjustability, along with supportive, protective side rails that can be raised or lowered, depending on patient or caregiver needs.

Hospital beds allow patients to sit up, and also to elevate specific areas of the body, for therapeutic and other purposes. The discomfort of leg swelling, for example, can be alleviated by elevating the legs in bed.

Bed height adjustability is a helpful feature for patients affected by mobility or balance issues, who may have difficulty getting in and out of bed. Raising and lowering a hospital bed can also make it easier to transfer a patient from the bed to a wheelchair or walker.

Patient mobility and the amount of time spent in bed are important considerations when selecting a mattress for a hospital bed. Many hospital bed mattresses are designed to reduce pressure on specific areas of the body, to help prevent bed sores. Foam, air, gel, and other mattress types are available for hospital beds, each with unique benefits.

Hospital beds can be rented or purchased, wheeled or stationary, and are available in a variety of styles. Let&#;s look at the most common types of hospital beds on the market today.

 

Manual Beds

Manual hospital beds are adjusted to different positions using a hand crank that&#;s built into the foot or head of the bed. The hand crank is used to raise or lower the mattress, so that either the upper half or the lower half of the patient&#;s body is elevated, as needed.

Manual beds have no electric adjustment capabilities, nor do they offer bed height adjustment. Manual bed adjustment options are more limited than what can be found with electric beds. Their simplicity, however, may be a benefit for patients not needing the bells and whistles of electric beds. If basic head (or foot) elevation is the only desired adjustment, a manual bed can be suitable for patient use at home. Manual beds are also less expensive than beds that come with electric capabilities.

 

Semi-Electric Beds

Semi-electric beds offer both manual and electric adjustment capabilities. A hand crank is used to manually raise or lower the height of the bed, while the head and foot areas are raised or lowered electrically. Bed height adjustment is helpful for caregivers who might otherwise strain their backs while assisting patients in bed. Corded electric controls make it easier for patients to reposition themselves, at the push of a button, in bed.

The semi-electric bed is a good option for patients who need the ability to raise and lower the bed, without the higher cost of a fully electric bed.

 

Full Electric Beds

Most modern medical facilities offer beds with full electrical adjustment features. On fully electric beds, motorized position and height adjustments are made with push-button controls. For patients (and caregivers) without the physical strength to operate the hand crank on a manual or semi-electric bed, the full electric bed provides an ideal solution for home use.

Corded touch control delivers a range of height and position adjustments, through easy, push-button commands. When frequent adjustments are needed through the day, full electric beds give patients more positioning options, with greater convenience than offered by manual or semi-electric beds. Some full electric beds have built-in scales, so that patient weights can be measured while the patient is in bed.

Patients who spend more than half the day in bed &#; or who are receiving long-term home care &#; tend to benefit the most from full electric beds. Manual and semi-electric beds are better for short-term use, as their adjustment options aren&#;t as advanced as those found on full electric beds.

 

Low Beds

Designed to prevent falls, and for those who may experience difficulty climbing into and out of bed, low hospital beds provide a wide range of heights, and can be lowered almost to floor level. Low beds can be manual or electric.

 

Safety Beds

Similar to cribs, safety beds feature high sides or railings, to prevent children from falling or climbing out of bed. Children in recovery, or in need of ongoing medical care, are kept safe by the protective barriers on safety beds.

 

Bariatric Beds

Featuring extra-wide frames, bariatric beds are built for heavy-duty use, to support a patient weighing up to pounds. Bariatric beds are larger and stronger than standard hospital beds, manual or electric, to provide positioning support to patients of compromised mobility.

 

Trendelenburg Beds

Full electric Trendelenburg Position beds offer more positioning adjustment and functionality options than any other hospital bed. They&#;re designed to facilitate medical procedures performed at odd angles, and to support the body in almost any position. Trendelenburg Beds are seldom needed for home use, but they represent the highest end of hospital beds.

Our health services division works directly with patients and their medical providers, delivering ventilation, mobility, and patient-care supplies. Contact CalOx to help understand which type of hospital bed is best for you or your patients.

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