Archived Policies - DME
Hospital Beds and Related Equipment
Various types of hospital beds may be medically necessary when the selected appropriate criteria are met:
Coverage will be allowed when ALL of the following guidelines are met:
Home use of the air-fluidized bed is considered not medically necessary in the following circumstances:
Power Floatation Therapy Bed/Alternating Pressure System
May be considered medically necessary if the patient meets one of the following combinations:
Criteria 1,2 & 3 or
Criteria 4 or
Criteria 5 & 6
Beds in this category may include,(but not limited to) Stryker Frame©, Circulo-Electric© and Oscillatory bed. These beds are not medically necessary as they are considered institutional equipment and inappropriate for home use.
Beds such as the Craftmatic ® Adjustable bed and the Sleep Number bed by Select Comfort Corporation are not medically necessary as the features of these beds are not needed for the appropriate care and treatment of a patient and are not hospital beds.
Mattresses may be considered medically necessary only when the hospital bed is used as a whole unit or if replacement become necessary.
Alternating Pressure Mattress and Pump or Gel/Water Floatation Pad
An alternating pressure mattress and/or pump or gel/water flotation pad may be considered medically necessary if one of the following combinations is met:
Criteria 2 or 3 with at least one of criteria 4-7
Bed Side Rails
Bed side rails may be considered medically necessary if required by the patient’s condition and they are an integral part of, or an accessory to a hospital bed. Some indications include but are not limited to:
Bed cradles may be considered medically necessary to prevent contact with bed coverings. Some indications include but are not limited to:
A trapeze bar may be considered medically necessary when a patient needs this device to sit up because of a respiratory condition, to change body position for other medical conditions, or to get in or out of bed.
Bed Boards and Over the Bed Tables
These items are not a covered benefit as they are considered convenience items.
Safety Net Enclosure
This is safety netting over a frame/canopy for use with a hospital bed to prevent falls. This item is not a covered benefit as its use is for institutional facilities only.
The patient's medical record must contain documentation substantiating their condition meets the above criteria.
Hospital beds allow the patient's position to be changed at the head and foot of the bed. In addition, the distance of the bed from the floor can be adjusted. In contrast, an ordinary bed has a fixed height from the floor and has no head or leg elevation adjustment.
Hospital beds may be:
Oscillatory beds were designed to assist with repositioning needs of the critically ill. Using a programmed unit, the bed shifts the position of the patient with minimal stimulation therefore reducing the oxygen demands needed for recuperation.
Beds used in the treatment of spinal cord injuries (Circulo-Electric©, RotoRest© or Stryker Frame©), are found in facilities such as hospitals.
The Craftmatic® Adjustable bed is a semi-electric bed with head and leg adjustment but no height adjustment. It has a choice of wireless or corded hand wand control that adjusts the head and foot of the bed. An electric mattress cover applies heat to that portion of the body touching the mattress. Dual controls are provided for dual-queen and dual king-size beds. A variety of massage options are available on Craftmatic Adjustable beds. This type of bed is not a hospital bed.
The Sleep Number bed has firmness settings between zero and 100 that can be adjusted by a hand held device that electronically adjusts the volume of air. Each side can be independently adjusted. A variety of accessories are available such as pillows, comforters, sheets and mattress pads. This type of bed is not a hospital bed.
Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.
If the projected cost of renting hospital beds or related equipment for temporary conditions exceeds the cost of purchasing the equipment, reimbursement should never exceed the purchase price.
If the cost of repair exceeds the cost of purchasing a new item or renting the item for the remaining period of medical need, the most cost effective alternative should be chosen.
Strauss, M.J., et al. The Cost Home Air-Fluidized Therapy for Pressure Sores. Journal of Family Practice (1991 July) 33(1): 52-59.
Nimit, K. Guidelines for Home Air-Fluidized Therapy. Health Technology Assessments (1989) 5:1-11 Medline Oct. 1992.
Perez, E. David M.D. Updated Guidelines for Treatment and Prevention. Geriatrics 1993 48:39-44.
DMERC Manual Pressure Reducing Support Surfaces Group 1 Chapter 32. (2000) http://www.palmettogba.com/palmetto/providers.nsf/(Docs)/85256CF40062C0E9852566C
DMERC Manual Pressure Reducing Support Surface Group 2 Chapter 33. (2000) http://www.palmettogba.com/palmetto/providers.nsf/PrintableDocs/85256CF40062C0E98
DMERC Manual Pressure Reducing Support Surfaces Group 3 Chapter 33. (2000) http://www.palmettogba.com/palmetto/providers.nsf/(DOCS)/85256CF40062C0E9852566C
|Title:||Effective Date:||End Date:|
|Hospital Beds and Related Equipment||01-15-2019||10-14-2019|
|Hospital Beds and Related Equipment||04-01-2017||01-14-2019|
|Hospital Beds and Related Equipment||04-01-2016||03-31-2017|
|Hospital Beds and Related Equipment||07-01-2015||03-31-2016|
|Hospital Beds and Related Equipment||05-15-2014||06-30-2015|
|Hospital Beds and Related Equipment||10-01-2008||05-14-2014|
|Hospital Beds and Related Equipment||04-15-2008||09-30-2008|
|Hospital Beds and Related Equipment||10-01-2006||04-14-2008|
|Hospital Beds and Related Equipment||07-15-2006||09-30-2006|
|Hospital Beds and Related Equipment||02-27-2004||07-14-2006|
|Hospital Beds and Related Equipment||08-01-2002||02-26-2004|