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Date Printed: October 20, 2017: 11:49 AM

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This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

09-E0000-12

Original Effective Date: 12/15/02

Reviewed: 03/24/11

Revised: 05/15/14

Subject: Hospital Beds and Accessories

THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION.

Position Statement Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines
Other References Updates  

DESCRIPTION:

A hospital bed is considered to be a piece of durable medical equipment that provides needed positioning for patients with specific medical needs.

Hospital beds can be categorized as follows:

Description

Height of Bed

Bed Height Adjustment

Head & Foot Adjustments

Standard

Fixed

Manual

Manual

Variable

Variable

Manual

Manual

Semi-electric

Variable

Manual

Electric

Total Electric

Variable

Electric

Electric

Heavy duty

Hospital bed capable of supporting patient weights of greater than 350 lbs, and less or equal to 600 lbs.

Extra heavy-duty

Hospital bed capable of supporting patient weights greater than 600 lbs.

Air-fluidized beds use warm air under pressure to set small ceramic beads in motion which simulate the movement of fluid. When the patient is placed in the bed, body weight is evenly distributed over a large surface area, which creates a sensation of "floating."

Institutional-type hospital beds include, but are not limited to, oscillating beds, springbase beds, circulating beds, cage beds, kinetic therapy (i.e., continuous lateral rotation therapy), and Stryker frame beds.

Enclosure beds (e.g., Pedicraft) are, padded beds that are completely enclosed with netting.

Power air-flotation beds – Medicare refers to these types of beds as Pressure Reducing Support Surfaces - Group 2.

POSITION STATEMENT:

The following hospital beds and equipment meet the definition of medical necessity when prescribed by a physician as medically necessary for the patient’s condition and when the following criteria are met for the type of bed or equipment prescribed:

Standard (fixed height) hospital beds may be covered when any of the following conditions exist:

Variable height hospital beds may be covered when one of the above criteria for a standard hospital bed are met and the patient requires adjustable height in order to transfer from bed to chair, wheelchair, or to a standing position.

Semi-electric hospital beds may be covered when one of the above criteria for a standard hospital bed are met and the patient requires frequent changes in position AND/OR has an immediate need for a change in body position.

Heavy-duty hospital beds may be covered when one of the above criteria for a standard hospital bed are met and the patient’s weight is greater than 350 pounds, but less than or equal to 600 pounds.

Extra heavy-duty hospital beds may be covered when one of the above criteria for a standard hospital bed are met and the patient’s weight is greater than 600 pounds.

Power air-flotation beds (Pressure Reducing Support Surfaces – Group 2) (E0193) may be covered when the following criteria are met:

  1. Criterion 1, 2 and 3, OR
  2. Criterion 4, OR
  3. Criterion 5 and 6.
  4. The patient has multiple stage II pressure ulcers located on the trunk or pelvis, AND
  5. The patient has been on a comprehensive ulcer treatment program for at least the past 30 days which has included the use of an appropriate group 1 support surface (E0181), AND
  6. The ulcers have worsened or remained the same over the past month, OR
  7. The patient has large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis, OR
  8. The patient had a recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days), AND
  9. The patient 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: A comprehensive ulcer treatment program generally includes the following:

Air-fluidized beds (Pressure Reducing Support Surfaces – Group 3) (E0194) may be covered for the treatment of pressure sores when ALL of the following criteria are met:

Accessories

Institutional-type hospital beds are inappropriate for home use; therefore these types of hospital beds do not meet the definition of medical necessity.

Enclosure beds (e.g., Pedicraft) are considered experimental or investigational as the U.S. FDA has determined that these devices pose significant safety risks.

Total electric hospital beds (electric height, head, and foot adjustment features) are generally member contract exclusions and are non-covered as convenience items.

Bed boards and over-bed tables do not meet the definition of medical necessity as these accessories do not meet criteria as durable medical equipment.

BILLING/CODING INFORMATION:

HCPCS Coding

Fixed Height Beds:

E0250

Hospital bed, fixed height, with any type side rails, with mattress

E0251

Hospital bed, fixed height, with any type side rails, without mattress

E0290

Hospital bed, fixed height, without side rails, with mattress

E0291

Hospital bed, fixed height, without side rails, without mattress

Variable Height Beds:

E0255

Hospital bed, variable height (hi-lo) with any type side rails, with mattress

E0256

Hospital bed, variable height (hi-lo) with any type side rails, without mattress

E0292

Hospital bed, variable height (hi-lo) without side rails, with mattress

E0293

Hospital bed, variable height (hi-lo) without side rails, without mattress

Semi-Electric Beds:

E0260

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress

E0261

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress

E0294

Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress

E0295

Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress

Total Electric Beds:

E0193

Powered air flotation bed (low air loss therapy)

E0194

Air-fluidized bed

E0265

Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress (non-covered)

E0266

Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, without mattress (non-covered)

E0270

Hospital bed, institutional type includes oscillating, circulating and stryker frame, with mattress (non-covered)

E0296

Hospital bed, total electric (head, foot, and height adjustments), without side rails, with mattress (non-covered)

E0297

Hospital bed, total electric (head, foot, and height adjustments), without side rails, without mattress (non-covered)

Heavy Duty Hospital Beds:

E0301

Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress

E0302

Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress

E0303

Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds but less than or equal to 600 pounds, with any type side rails, with mattress

E0304

Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds with any type side rails, with mattress

Pediatric Hospital Beds:

E0300

Pediatric crib, hospital grade, fully enclosed, with or without top enclosure (investigational)

E0328

Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress

E0329

Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress

Hospital Bed Accessories:

E0181

Powered pressure reducing mattress overlay/pad, alternating with pump, includes heavy duty

E0184

Dry pressure mattress

E0185

Gel or gel-like pressure pad for mattress, standard mattress length and width

E0186

Air pressure mattress

E0196

Gel pressure mattress

E0197

Air pressure pad for mattress, standard mattress length and width

E0199

Dry pressure pad for mattress, standard mattress length and width

E0271

Mattress, innerspring

E0272

Mattress, foam rubber

E0273

Bed board (non-covered)

E0274

Over-bed table (non-covered)

E0277

Powered pressure-reducing air mattress

E0280

Bed cradle, any type

E0305

Bedside rails, half-length

E0310

Bedside rails, full-length

E0315

Bed accessory: board OR table OR support device, any type (non-covered)

E0316

Safety enclosure frame/canopy for use with hospital bed, any type (investigational)

E0910

Trapeze bars, also known as Patient Helper, attached to bed, with grab bar

E0911

Trapeze bar, heavy-duty, for patient weight capacity greater than 2560 pounds, attached to bed, with grab bar

E0912

Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, freestanding, complete with grab bar

E0940

Trapeze bar, freestanding, complete with grab bar

E0371

Non-powered advanced pressure reducing overlay for mattress, standard mattress length and width

E0372

Powered air overlay for mattress, standard mattress length and width

E0373

Non-powered advanced pressure reducing mattress

REIMBURSEMENT INFORMATION:

Reimbursement is made for hospital beds and accessories according to purchase or rental (rental allowance not to exceed the purchase price).

Mattresses AND/OR side rails are not reimbursed separately when they are an integral part of the hospital bed.

Reimbursement for replacement mattresses is made for patient-owned hospital beds only.

Codes in Column II are included in (incidental to) the allowance for the corresponding code in Column I and are not reimbursed separately:

Column I

Column II

E0250

E0271, E0272, E0305, E0310

E0251

E0305, E0310

E0255

E0271, E0272, E0305, E0310

E0256

E0305, E0310

E0260

E0271, E0272, E0305, E0310

E0261

E0305, E0310

E0265

E0271, E0272, E0305, E0310

E0266

E0305, E0310

E0290

E0271, E0272

E0292

E0271, E0272

E0294

E0271, E0272

E0296

E0271, E0272

E0301

E0305, E0310

E0302

E0305, E0310

E0303

E0271, E0272, E0305, E0310

E0304

E0271, E0272, E0305, E0310

E0328

E0271, E0272, E0305, E0310

E0329

E0271, E0272, E0305, E0310

PROGRAM EXCEPTIONS:

Federal Employee Program (FEP): Follow FEP guidelines.

State Account Organization (SAO): Follow SAO guidelines.

Medicare Advantage products:

The following National Coverage Determination (NCD) was reviewed on the last guideline reviewed date: Hospital Beds (280.7) and Air-Fluidized Bed (280.8) located at cms.gov.

The following Durable Medical Equipment Regional Carrier (DMERC) Local Coverage Determination (LCD) was reviewed on the last guideline reviewed date: Hospital Beds (L11557), Pressure Reducing Support Surfaces Group 1 (L11563), Pressure Reducing Support Surfaces Group 2 (L11564), and Pressure Reducing Support Surfaces Group 3 (L11565) located at cgsmedicare.com.

DEFINITIONS:

Air-fluidized hospital bed: uses warm air under pressure to set small ceramic beads in motion which simulate the movement of fluid. When the patient moves and repositions, the body weight is evenly distributed over a large surface area that creates a “floating” sensation.

Decubitus of pressure sore, stage 4: deep tissue destruction.

Decubitus or pressure sore, stage 3: full thickness tissue loss.

Fixed height hospital bed: one with manual head and leg elevation adjustments but no height adjustment.

Semi-electric hospital bed: one with manual height adjustment and with electric head and leg elevation adjustments.

Total electric hospital bed: one with electric height adjustment and with electric head and leg elevation adjustments.

Variable height hospital bed: one with manual height adjustment and with manual head and leg elevation adjustments.

RELATED GUIDELINES:

Durable Medical Equipment (DME), 09-E0000-01

OTHER:

None applicable.

REFERENCES:

  1. Centers for Medicare & Medicaid Services (CMS) DMERC LCD for Hospital Beds (L11557). 02/04/11.
  2. Centers for Medicare & Medicaid Services (CMS) DMERC LCD for Pressure Reducing Support Surfaces 1 (L11564). 12/01/09.
  3. Centers for Medicare & Medicaid Services (CMS) DMERC LCD for Pressure Reducing Support Surfaces 2 (L11564). 04/01/10.
  4. Centers for Medicare & Medicaid Services (CMS) DMERC LCD for Pressure Reducing Support Surfaces 3 (L11565). 04/01/10.
  5. Centers for Medicare and Medicaid Services (CMS) National Coverage Determination for Hospital Beds (280.7), last modified 04/23/09.
  6. Centers for Medicare and Medicaid Services (CMS) National Coverage Determination for Air-Fluidized Bed (280.8), last modified 04/23/09.
  7. McKesson InterQual® criteria for Durable Medical Equipment; Hospital Beds (2009).
  8. Medicare Coverage Issues Manual (CIM 60-18 and 60-19).
  9. St. Anthony’s ICD-9-CM Code Book (current edition).
  10. U.S. Food and Drug Administration (FDA) Public Health Notification: Vail Products Enclosed Bed Systems. (Original Date 03/25/05; Updated 06/24/05 and 12/04/07).

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 03/24/11.

GUIDELINE UPDATE INFORMATION:

12/15/02

Medical Coverage Guideline Reformatted.

01/01/04

Annual HCPCS coding update.

10/15/04

Scheduled review; no change in coverage statement.

12/15/04

Revision consisting of addition of coverage criteria for air-fluidized beds.

05/15/07

Guideline archived.

11/15/09

Guideline reinstated to active status; document reformatted; position statement unchanged; reimbursement section revised to include incidental coding relationships; definitions added; references updated.

04/15/11

Revisions to add information regarding power air-flotation beds, institutional beds, and enclosure beds. References updated.

09/15/11

Revisions: Billing/Coding section updated to include additional codes for pediatric beds.

01/01/13

Annual HCPCS coding update; revised descriptor for E0300.

05/15/14

Revision; Program Exceptions section updated.

Date Printed: October 20, 2017: 11:49 AM