Draft Policies - DME


Hospital Beds and Related Equipment

Number:DME101.001

Posted Date:08-15-2018

Comment Period Ends:09-01-2018

Coverage:

*CAREFULLY CHECK STATE REGULATIONS AND/OR THE MEMBER CONTRACT*

HOSPITAL BEDS:

A fixed height hospital bed (HCPCS codes E0250, E0251, E0290, or E0291) may be considered medically necessary if one or more of the following criteria are met:

1. The individual requires positioning of the body to alleviate pain, promote good body alignment, prevent contractures and/or avoid respiratory infection, in ways not feasible with an ordinary bed;

2. The individual 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. NOTE 1: Pillows or wedges should first have been considered and ruled out. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed; or

3. The individual requires special attachments (e.g., traction equipment) that cannot be attached to or used with an ordinary bed.

A variable height hospital bed (HCPCS codes E0255, E0256, E0292, or E0293) may be considered medically necessary if the individual meets one or more 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. This includes, but is not limited to:

Severe arthritis;

Fractured hips or other lower extremity injuries;

Spinal cord injuries, including quadriplegia and paraplegia, multiple limb amputees;

Severe cardiac conditions (those individuals who are able to leave the bed, but must avoid the strain of “jumping” up or down); or

Stroke.

A semi-electric hospital bed (HCPCS codes E0260, E0261, E0294, or E0295) may be considered medically necessary if the individual meets one or more of the criteria for a fixed height hospital bed and requires frequent changes in body position or has an immediate need for a change in body position.

A heavy-duty, extra wide hospital bed (HCPCS codes E0301 or E0303) may be considered medically necessary if the individual meets one or more of the criteria for a fixed height hospital bed, and the individual’s weight is more than 350 pounds, but does not exceed 600 pounds.

An extra heavy-duty hospital bed (HCPCS codes E0302 or E0304 may be considered medically necessary if the individual meets one or more of the criteria for a fixed height hospital bed and the individual’s weight exceeds 600 pounds.

A total electric hospital bed (HCPCS codes E0265, E0266, E0296, or E0297) is rarely indicated except in cases of spinal cord injuries, brain injuries, and individuals with neurological damage that prevents them from getting in or out of bed. These individuals also require assistance with the basic activities of daily living (i.e., bathing, use of toilet).

Air-fluidized Beds:

Coverage of an air-fluidized bed (HCPCS code E0194) may be considered medically necessary when all the following criteria are met:

The individual has a stage III (full thickness tissue loss) or stage IV (deep tissue destruction) pressure sore; AND

The individual is bedridden or chair-bound as a result of limited mobility; AND

In the absence of an air-fluidized bed, the individual would require institutionalization; AND

The bed is ordered by the individual's attending physician based upon a comprehensive assessment and evaluation of the individual after a course of conservative treatment designed to optimize conditions that promote wound healing. The evaluation must be performed within one month prior to initiation of therapy with the air-fluidized bed; AND

The course of conservative treatment must have been at least one month in duration without progression toward wound healing. This month of prerequisite conservative treatment may include some period in an institution as long as there is documentation to verify that the necessary conservative treatment was rendered. Conservative treatment should include:

1. Frequent repositioning of the individual with particular attention to relief of pressure over bony prominences (usually every two hours); and

2. Use of a Group 2 support surface (see Pressure Reducing Support Services below) to reduce pressure and shear forces on healing ulcers and to prevent new ulcer formation; and

3. Necessary treatment to resolve any wound infection; and

4. Optimization of nutrition status to promote wound healing; and

5. Debridement by any means, including wet to dry gauze dressings, to remove devitalized tissue from the wound bed; and

6. Maintenance of a clean, moist bed of granulation tissue with appropriate moist dressing protected by an occlusive covering, while the wound heals; and

7. Education of the individual/caregiver in the prevention and management of pressure ulcers; and

8. Assessment by a physician, nurse, or other licensed healthcare practitioner at least weekly; and

9. Appropriate management of moisture/incontinence; AND

The availability of a trained adult caregiver to assist with activities of daily living, repositioning, skin care, fluid balance, dry skin care, recognition and management of altered mental status, dietary needs, prescribed treatments and management and support of the air-fluidized bed system and potential problems such as leakage; AND

Physician directed home treatment regimen with ongoing physician directed assessment; AND

All other alternative equipment has been considered and ruled out.

Home use of the air-fluidized bed is considered not medically necessary in the following circumstances:

Presence of coexisting pulmonary disease (the lack of firm back support makes coughing ineffective and dry air inhalation thickens pulmonary secretions); or

Requires treatment with wet soaks or moist wound dressings that are not protected with an impervious covering such as plastic wrap or occlusive material; or

Other known contraindications exist.

NOTE 2: Coverage for the air-fluidized bed is limited to the equipment itself, and does not include reimbursement for the caregiver or, architectural adjustments such as electrical or structural improvements.

Continued coverage of an air-fluidized bed may be considered medically necessary until the ulcer is healed, or, if healing does not continue, there is documentation to show that:

Other aspects of the care plan are being modified to promote healing; or,

The use of the bed is necessary for wound management.

NOTE 3: Air-fluidized beds are classified as a Group 3 Pressure Reducing Support Surface by The Centers for Medicare and Medicaid Services.

Pressure Reducing Support Surfaces

Group 1 Support Surfaces (as Defined in the Description) (HCPCS codes A4640, E0181, E0182, E0184, E0185, E0186, E0187, E0188, E0189, E0196, E0197, E0198, E0199, or E0272)

A Group 1 mattress overlay or mattress may be considered medically necessary if the individual meets:

Criterion 1, or

Criterion 2 or 3 and at least one of criteria 4-7:

1. Completely immobile – that is, individual cannot make changes in body position without assistance;

2. Limited mobility – that is, individual cannot independently make changes in body position significant enough to alleviate pressure;

3. Any stage pressure ulcer on the trunk or pelvis;

4. Impaired nutritional status;

5. Fecal or urinary incontinence;

6. Altered sensory perception;

7. Compromised circulatory status.

A Group 1 support surface is considered not medically necessary when the criteria listed above are not met.

Group 2 Support Surfaces (as Defined in the Description) (HCPCS codes E0193, E0277, E0371, E0372, E0373)

A Group 2 support surface may be considered medically necessary if the individual meets:

Criteria 1 and 2 and 3, or

Criterion 4, or

Criteria 5 and 6

1. Multiple stage II pressure ulcers located on the trunk or pelvis;

2. Individual has been on a comprehensive ulcer treatment program (*see NOTE 4) for at least the past 30 days that has included the use of an appropriate group 1 support surface;

3. The ulcers have worsened or remained the same over the past month;

4. Large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis;

5. Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days);

6. The individual has been on a group 2 or 3 support surface immediately prior to a recent discharge from a hospital or nursing facility (discharge within the past 30 days).

NOTE 4: The comprehensive ulcer treatment program described above should generally include:

Education of the individual and caregiver on the prevention and/or management of pressure ulcers; AND

Regular assessment by a nurse, physician or other licensed healthcare practitioner (usually at least weekly for an individual with a stage III or IV ulcer); AND

Appropriate turning and positioning; AND

Appropriate wound care (for a stage II, III or IV ulcer); AND

Appropriate management of moisture/incontinence; AND

Nutritional assessment and intervention consistent with the overall plan of care.

Continued use of a group 2 support surface may be considered medically necessary until the ulcer is healed or, if healing does not continue, there is documentation in the medical record to show that:

Other aspects of the care plan are being modified to promote healing; or

The use of the group 2 support surface is medically necessary for wound management.

When a group 2 pressure reducing support surface is prescribed following a myocutaneous flap or skin graft, continued use may be considered medically necessary for up to 60 days from the date of surgery.

INSTITUTIONAL BEDS: (HCPCS code E0270)

Beds in this category may include, but are not limited to, Stryker Frame™, Circulo-Electric™ and Oscillatory bed. These beds are considered not medically necessary as they are considered institutional equipment and inappropriate for home use.

MISCELLANEOUS BEDS:

Beds such as the Craftmatic® Adjustable bed, the Sleep Number® bed by Select Comfort Corporation and the Self Adjusting Technology (SAT™) Bed, the SleepSafe Beds®, and waterbeds are considered not medically necessary as they are not hospital beds and are not suited for the appropriate care and treatment of patients.

MATTRESS REPLACEMENT:

The replacement of a mattress for a medically necessary hospital bed may be considered medically necessary.

RELATED EQUIPMENT:

Bed Side Rails (HCPCS codes E0305, E0310)

Bed side rails may be considered medically necessary if required by the individual’s condition and are integral parts of, or an accessory to a hospital bed. Some indications include but are not limited to:

Confusion/disorientation;

Vertigo(dizziness);

Seizures; or

Senile dementia or psychosis.

Bed Cradle (HCPCS code E0280)

Bed cradles may be considered medically necessary to prevent contact with bed coverings. Some indications include but are not limited to:

Burns;

Gangrene of the feet; and

Impaired circulation in the feet.

Trapeze Bars (HCPCS codes E0910, E0911, E0912, E0940)

A trapeze bar may be considered medically necessary when an individual 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 (HCPCS codes E0273, E0274, E0315)

These items are considered not medically necessary as they are considered convenience items.

Safety Net Enclosure (HCPCS code E0316)

The use of safety netting placed over a hospital bed frame or canopy, to prevent falls, is considered not medically necessary. These devices are intended for institutional use only.

NOTE 5: For further information related to durable medical equipment (DME) see DME101.000 DME Introduction.

Description:

Hospital beds allow the individual'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.

The following are descriptions of various types of hospital beds:

Fixed height beds have manual head and leg elevation adjustments but not bed height adjustment;

Variable height beds have manual height adjustments and with electric head and leg elevation adjustments;

Semi electric beds have manual height adjustment and electric head and leg adjustments;

Total electric beds have electric height adjustments and electric head and leg adjustments; these additional features allow for motorized adjustment of the height of the bed frame from the floor and are strictly for the convenience of the caregiver. The caregiver may have physical limitations in his/her ability to care for the individual;

A heavy duty extra wide hospital bed is capable of supporting an individual weight between 350 and 600 pounds;

An extra heavy duty bed is a bed able to support individual weight of more than 600 pounds;

An air fluidized therapy bed is a device employing the circulation of filtered air through silicone coated ceramic beads creating the characteristics of fluid. Uses include, treatment and/or prevention of decubitus ulcers, management of severe or extensive burns, and to aid the circulation of blood;

A powered flotation therapy bed is a semi-electric or totally-electric hospital bed with a fully integrated powered pressure reducing mattress, containing a large volume of constantly moving water, air or sand. Uses include treatment and/or prevention of decubitus ulcers, management of severe or extensive burns, and to aid in the circulation of blood.

Miscellaneous beds:

Oscillatory beds were designed to assist with repositioning needs of the critically ill. Using a programmed unit, the bed shifts the position of the individual 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.

The Self Adjusting Technology (SAT™) bed contains an air suspension system with intake and out take valves that are claimed to automatically adjust to each individual regardless of body weight. The design of the bed makes it possible to adjust the volume of air without need for pumps, motors or electricity.

The SleepSafe Beds® address concerns of safety (e.g. entrapment issues and prevention of falls with increased safety rail height). These beds are available with a variety of functions and features (e.g. either electric or non-electric foundations, with or without padding etc).

Pressure Reducing Support Surfaces

Pressure reducing support surfaces are designed to prevent or promote the healing of pressure ulcers by reducing or eliminating tissue interface pressure. Most of these devices reduce interface pressure by conforming to the contours of the body so that pressure is distributed over a larger surface area rather than concentrated on a more restricted site. Pressure reducing support surfaces that contain multiple components are categorized according to the clinically predominant component, which is usually the topmost layer of a multi-layer product.

Group 1 pressure reducing support surface include: pressure pads for mattresses, non-powered pressure reducing mattresses and powered pressure reducing mattress overlay systems.

Pressure pads for mattresses describe non-powered pressure reducing mattress overlays. These devices are designed to be placed on top of a standard hospital or home mattress. These include:

A gel or gel-like mattress overlay is characterized by a gel or gel-like layer with a height of 2 inches or greater.

An air mattress overlay is characterized by interconnected air cells having a cell height of 3 inches or greater that are inflated with an air pump.

A water mattress overlay is characterized by a filled height of 3 inches or greater.

A foam mattress overlay is characterized by all of the following:

o Base thickness of 2 inches or greater and peak height of 3 inches or greater if it is a convoluted overlay (e.g., egg crate) or an overall height of at least 3 inches if it is a non-convoluted overlay;

o Foam with a density and other qualities that provide adequate pressure reduction; and,

o Durable, waterproof cover.

Non-powered pressure reducing mattresses include:

A foam mattress characterized by all of the following:

o Foam height of 5 inches or greater;

o Foam with a density and other qualities that provide adequate pressure reduction;

o Durable, waterproof cover;

o Can be placed directly on a hospital bed frame.

An air, water or gel mattress characterized by all of the following:

o Height of 5 inches or greater of the air, water or gel layer

o Durable, waterproof cover

o Can be placed directly on a hospital bed frame.

Powered pressure reducing mattress overlay systems (alternating pressure or low air loss) are characterized by all of the following:

An air pump or blower that provides either sequential inflation and deflation of air cells or a low interface pressure throughout the overlay;

Inflated cell height of the air cells through which air is being circulated is 2.5 inches or greater; AND

Height of the air chambers, proximity of the air chambers to one another, frequency of air cycling (for alternating pressure overlays), and air pressure provide adequate member lift, reduce pressure and prevent bottoming out.

Group 2 pressure reducing support surface include powered pressure reducing mattresses, semi-electric hospital beds with powered pressure reducing mattresses, powered pressure reducing mattress overlays, advanced non-powered pressure reducing mattresses and advanced non-powered pressure reducing mattress overlays.

A powered pressure reducing mattress (alternating pressure, low air loss, or powered flotation without low air loss) is characterized by all of the following:

An air pump or blower that provides either sequential inflation and deflation of the air cells or a low interface pressure throughout the mattress; AND

Inflated cell height of the air cells through which air is being circulated is 5 inches or greater; AND

Height of the air chambers, proximity of the air chambers to one another, frequency of air cycling (for alternating pressure mattresses), and air pressure provide adequate member lift, reduce pressure, and prevent bottoming out; AND

A surface designed to reduce friction and shear; AND

Can be place directly on a hospital bed frame.

A semi-electric hospital bed with a fully integrated powered pressure reducing mattress that has all the characteristics defined above is considered a group 2 pressure reducing support surface.

An advanced non-powered pressure reducing mattress overlay is characterized by all of the following:

Height and design of individual cells provide significantly more pressure reduction than a group 1 overlay and prevent bottoming out; AND

Total height of 3 inches or greater; AND

A surface designed to reduce friction and shear; AND

Documented evidence to substantiate that the product is effective for the treatment of condition described by the coverage criteria for group 2 support surfaces.

A powered pressure reducing mattress overlay (low air loss, powered flotation without low air loss, or alternating pressure) is characterized by all of the following:

An air pump or blower that provides either sequential inflation and deflation of the air cells or a low interface pressure throughout the overlay; AND

Inflated cell height of the air cells through which air is being circulated is 3.5 inches or greater; AND

Height of the air chambers, proximity of the air chambers to one another, frequency of air cycling (for alternating pressure overlays), and air pressure to provide adequate member lift, reduce pressure, and prevent bottoming out; AND

A surface designed to reduce friction and shear.

An advanced non-powered pressure reducing mattress is characterized by all of the following:

Height and design of individual cells provide significantly more pressure reduction than a group 1 mattress and prevent bottoming out ; AND

Total height of 5 inches or greater; AND

A surface designed to reduce friction and shear; AND

Documented evidence to substantiate that the product is effective for the treatment of conditions described by the coverage criteria for group 2 support surfaces; AND

Can be placed directly on a hospital bed frame.

For all types of support surfaces, the support surface provided should be one in which the individual does not “bottom out.” Bottoming out is the finding that an outstretched hand, placed palm up between the undersurface of the overlay or mattress and the individual’s bony prominence (coccyx or lateral trochanter), can readily palpate the bony prominence. This bottoming out criterion should be tested with the individual in the supine position with their head flat, in the supine position with their head slightly elevated (no more than 30 degrees), and in the side lying position.

Pressure reducing support surfaces that contain multiple components are categorized according to the clinically predominant component, which is usually the topmost layer of a multi-layer product. For example, a product with 3-inch powered air cells on top of a 3-inch foam base would be categorized as a powered overlay not as a powered mattress.

Pressure Injury Stages

A pressure injury is localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities, and condition of the soft tissue.

Table 1: Pressure Injury Stages

Stage

Description

Stage 1 Pressure Injury: Non-blanchable erythema of intact skin

Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury.

Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis

Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. These injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel. This stage should not be used to describe moisture associated skin damage (MASD) including incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), medical adhesive related skin injury (MARSI), or traumatic wounds (skin tears, burns, abrasions).

Stage 3 Pressure Injury: Full-thickness skin loss

Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds. Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

Stage 4 Pressure Injury: Full-thickness skin and tissue loss

Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

Unstageable Pressure Injury: Obscured full-thickness skin and tissue loss

Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed. Stable eschar (i.e. dry, adherent, intact without erythema or fluctuance) on the heel or ischemic limb should not be softened or removed.

Deep Tissue Pressure Injury (DTPI): Persistent non-blanchable deep red, maroon or purple discoloration

Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface. The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss. If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle or other underlying structures are visible, this indicates a full thickness pressure injury (Unstageable, Stage 3 or Stage 4). Do not use DTPI to describe vascular, traumatic, neuropathic, or dermatologic conditions.

Rationale:

This policy was originally developed in 1990 and has been routinely updated with new information from the Centers for Medicare and Medicaid Services National Coverage Determinations and any Local Coverage Determinations available. This policy is based in large part on the Centers for Medicare and Medicaid Services National and Local Coverage Determinations on Hospital Beds and Pressure Reducing Support Services.

Coverage for hospital beds must be reasonable and necessary for the treatment of the individual patient. A physician must provide a certificate of medical necessity for the appropriate equipment needed. Medical necessity information should include the diagnosis, a narrative description of the individual's condition, abilities, and limitations and the length of need of the item prescribed. The medical records may include physician’s office records, hospital records, nursing home records, home health agency records, and/or records from other healthcare professionals.

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:

CODING:

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.

CPT/HCPCS/ICD-9/ICD-10 Codes

The following codes may be applicable to this Medical policy and may not be all inclusive.

CPT Codes

None

HCPCS Codes

A4640, E0181, E0182, E0184, E0185, E0186, E0187, E0188, E0189, E0193, E0194, E0196, E0197, E0198, E0199, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0270, E0271, E0272, E0273, E0274, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0315, E0316, E0328, E0329, E0371, E0372, E0373, E0910, E0911, E0912, E0940

ICD-9 Diagnosis Codes

Refer to the ICD-9-CM manual

ICD-9 Procedure Codes

Refer to the ICD-9-CM manual

ICD-10 Diagnosis Codes

Refer to the ICD-10-CM manual

ICD-10 Procedure Codes

Refer to the ICD-10-CM manual


Medicare Coverage:

The information contained in this section is for informational purposes only. HCSC makes no representation as to the accuracy of this information. It is not to be used for claims adjudication for HCSC Plans.

The Centers for Medicare and Medicaid Services (CMS) does have a national Medicare coverage position.

A national coverage position for Medicare may have been changed since this medical policy document was written. See Medicare's National Coverage at <http://www.cms.hhs.gov>.

References:

1. Centers for Medicare and Medicaid Services National Coverage Determination (NCD) for Hospital beds (280.7). Available at: <https://www.cms.gov.> Accessed June 25, 2018.

2. Centers for Medicare and Medicaid Services National Coverage Determination (NCD) for Air fluidized Bed (280.8). Available at: <https://www.cms.gov.> Accessed June 25, 2018.

3. SleepSafe Beds® The Safety Bed. Product information. Available at <http://sleepsafebed.com>. Accessed February 9, 2016.

4. Local Coverage Determination (LCD): Pressure Reducing Support Surfaces – Group 1 (L33830). Available at: <https://www.cms.gov>. Accessed June 25, 2018.

5. Local Coverage Determination (LCD): Pressure Reducing Support Surfaces – Group 2 (L33642). Available at: <https://www.cms.gov>. Accessed June 25, 2018.

6. Local Coverage Determination (LCD): Pressure Reducing Support Surfaces – Group 3 (L33692). Available at: <https://www.cms.gov>. Accessed June 25, 2018.

7. Local Coverage Determination (LCD): Hospital Beds and Accessories (L33820). Available at: <https://www.cms.gov>. Accessed June 25, 2018.

8. Local Coverage Article (LCA): Hospital Beds and Accessories – Policy Article (A52508). Available at: <https://www.cms.gov>. Accessed June 25, 2018.

9. National Pressure Ulcer Advisory Panel NPUAP Pressure Injury Stages. (2016). Available at: <https://www.npuap.org>. Accessed June 27, 2018.

Policy History:

DateReason TBD Document updated with literature review. Coverage unchanged. References revised; added references 7-9.
4/1/2017 Reviewed. No changes.
4/1/2016 Document updated with literature review. Coverage unchanged.
7/1/2015 Reviewed. No changes.
5/15/2014 Document updated with literature review. The following example was added to the MISCELLANEOUS BEDS statement: SleepSafe Beds®. The wording was changed to include “considered not medically necessary” to the following coverage sections “Bed Boards and Over the Bed Tables” and “Safety Net Enclosure”. CPT/HCPCS code(s) updated.
10/1/2008 CPT/HCPCS code(s) updated
4/15/2008 Policy reviewed without literature review; new review date only. This policy is no longer scheduled for routine literature review and update.
1/1/2008 CPT/HCPCS code(s) updated, medical policy unchanged
10/1/2006 Revised/updated entire document
2/1/2004 Revised/updated entire document
8/1/2002 Revised/updated entire document
9/1/1999 Revised/updated entire document
5/1/1996 Revised/updated entire document
6/1/1991 Revised/updated entire document
5/1/1990 New medical document

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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