Archived Policies - DME


Hospital Beds and Related Equipment

Number:DME101.001

Effective Date:08-01-2002

End Date:02-26-2004

Coverage:

HOSPITAL BEDS

Hospital beds are medically necessary when the following criteria are met:

A.  Fixed Height:   (one or more of the following is required):

o     The patient requires positioning of the body for the alleviation of pain in ways not feasible with an ordinary bed.

o     The patient requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration.  Pillows or wedges should first have been considered.

o     The patient requires traction equipment that can only be attached to a hospital bed.

B.   Variable Height :   (in addition to one of the above):

o     The patient requires a bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair or standing position.

C.  Semi-Electric:

o     In addition to the above indications, the patient requires frequent or immediate changes in body position.

D.  Total Electric:

o     This type of bed is rarely indicated except in cases of spinal cord injuries, brain damaged patients and patients with neurological damage that prevents them from getting in or out of bed. These patients also require assistance with the basic activities of daily living (i.e., bathing, use of toilet).

Oscillating beds are not medically necessary as they are considered institutional equipment and inappropriate for home use.

Miscellaneous beds such as the Craftmatic (R) 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.

HOSPITAL BEDS AND RELATED EQUIPMENT

Mattress:

Mattresses are medically necessary only when a hospital bed is determined to be medically necessary.

Alternating pressure pad and pump or Gel Flotation Pad:

An alternating pressure pad and/or pump or gel flotation pad are medically necessary for the following:

o     Decubitus ulcers (pressure sores)

o     Patient is highly susceptible to decubitus ulcers

o     Quadriplegia/Paraplegia

o     History of recurrent decubitus ulcers despite proper nursing care.

Bed Side Rails:

Bed side rails are medically necessary if the patient has one of the following conditions:

o     Confusion/disorientation

o     Vertigo(dizziness)

o     Seizures

o     Senile dementia or psychosis

o     Senility

Bed Cradle: 

Bed cradles are medically necessary for patients with one of the following conditions:

o     Burns

o     Gangrene of the feet

o     Impaired circulation in the feet.

Bed Boards and Over the Bed Tables: 

These items are not a covered benefit as they are considered convenience items.

Trapeze Bars:  

A trapeze bar is 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.

Documentation: 

The patient's medical record must contain documentation substantiating that their condition meets the above criteria.

Description:

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:

o     Totally manual and of fixed height with manual (a cranking mechanism) head and leg elevation adjustments, but no height adjustment.

o     Totally manual with variable height and manual height adjustment.

o     Semi-electric (electric head and leg adjustment), with manual height adjustment;

o     Total electric, having electric head and leg adjustment and electric height adjustment. The additional feature allowing for motorized adjustment of the height of the bed frame from the floor is strictly for the convenience of the caregiver.  The caregiver may have physical limitations in his/her ability to care for the patient.

This policy also addresses various accessories and equipment used in the care of bed bound patients.

Miscellaneous beds

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 amount 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.

Rationale:

None

Contract:

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.

Coding:

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.


Medicare Coverage:

None

References:

Http://www.hcfa.gov/pubforms/06_cim/ci60.htm Coverage Issues Manual,60-18 through 60-22, Hospital Beds

Policy History:

Archived Document(s):

Title:Effective Date:End Date:
Hospital Beds and Related Equipment04-01-201701-14-2019
Hospital Beds and Related Equipment04-01-201603-31-2017
Hospital Beds and Related Equipment07-01-201503-31-2016
Hospital Beds and Related Equipment05-15-201406-30-2015
Hospital Beds and Related Equipment10-01-200805-14-2014
Hospital Beds and Related Equipment04-15-200809-30-2008
Hospital Beds and Related Equipment10-01-200604-14-2008
Hospital Beds and Related Equipment07-15-200609-30-2006
Hospital Beds and Related Equipment02-27-200407-14-2006
Hospital Beds and Related Equipment08-01-200202-26-2004
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