Hospital Bed – DME

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					Hospital Bed – DME
Administrative Process

Prior approval is required except as follows:

•     NOTE: Up to 3 months rental of a hospital bed will be approved without medical review, but notification is
      required by vendor within 30 days of providing the item. Clinics should direct member to contact DME
      vendor to order the hospital bed.
•     On-going rentals or purchases are subject to all of the criteria and documentation requirements noted in this
      policy and require prior approval.

Prior approval is not required for rental items for members enrolled in a hospice program.

Coverage
Generally covered subject to the indications listed below and the following limits from your member contract:
   1. The medical care, services, supplies, and equipment that are listed as covered services must be medically
        necessary. Medically necessary Services or supplies that are proper and needed for the diagnosis or
        treatment of your medical condition; are used for the diagnosis, direct care, and treatment of your medical
        condition; meet the standards of good medical practice in the local community; and are not mainly for the
        convenience of you or your doctor.
   2. Personal convenience items, such as a telephone or television in your room at a hospital or skilled nursing
        facility, are excluded from coverage. This would include:
        a. Items for hygiene, vocation, comfort, convenience or recreation.
        b. Duplicate or similar items. Requests for replacement DME when existing DME is not broken, requires a
              physician statement documenting a change in the covered person's physical condition, and the medical
              reasons for the replacement DME.
   4. Unless medically necessary, elective or voluntary enhancement supplies including but not limited to items
        used for: weight loss, hair growth, sexual performance, athletic performance, cosmetic purposes, anti-aging
        and mental performance.
   5. DME and supplies must be obtained from or repaired by contracted vendors for in network benefits to apply.

Indications that are covered

1.    General Requirements for Coverage of Hospital Beds: A physician's prescription and such additional
      documentation as the contractors' medical staffs may consider necessary, including medical records and
      physicians' reports, must establish the medical necessity for a hospital bed due to one of the following reasons:
      •     The patient's condition requires positioning of the body; e.g., to alleviate pain, promote good body alignment,
            prevent contractures, avoid respiratory infections, in ways not feasible in an ordinary bed; or
      •    The patient's condition requires special attachments that cannot be fixed and used on an ordinary bed.
2     Physician's Prescription: The physician's prescription, which must accompany the initial claim, and
      supplementing documentation when required, must establish that a hospital bed is medically necessary. If the
      stated reason for the need for a hospital bed is the patient's condition requires positioning, the prescription or
      other documentation must describe the medical condition, e.g., cardiac disease, chronic obstructive pulmonary
      disease, quadriplegia or paraplegia, and also the severity and frequency of the symptoms of the condition that
      necessitates a hospital bed for positioning. If the stated reason for requiring a hospital bed is the patient's
      condition requires special attachments, the prescription must describe the patient's condition and specify the
      attachments that require a hospital bed.
3.    Medical condition requires features of a hospital bed (height adjustment, head and foot adjustments) or special
      attachments, which are not available for use with ordinary beds. Evaluation will include review of diagnosis,
      severity, and frequency of symptoms. The following is a list, though not all inclusive, of examples:
      a. Medical condition requires frequent changes in positions (i.e. every 1-2 hours or more frequently).
      b. Medical condition may require immediate changes in position (i.e. no delay can be tolerated, such as with
           potential aspiration or severe respiratory problems).
      c. Medical condition requires positioning of the body, such as to alleviate pain, promote good body alignment,
           prevent contractures, avoid respiratory infections, etc.
      d. Evaluation will include review of diagnosis, severity and frequency of symptoms.
      e. Medical condition would be adversely affected by strain of transfers.

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      f.    Severe debilitating condition requiring bed adjustments for transfers.
      g.    The patient's condition requires special attachments that cannot be fixed and used on an ordinary bed.

Covered Accessories – No prior approval required
1.    Trapeze equipment (E0910, E0940 - regular; E0911 & E0912 – heavy duty) is covered if the patient needs this
      device to sit up because of a respiratory condition, to change body position for other medical reasons, or to get in
      or out of bed.
2.    A bed cradle (E0280) is covered when it is necessary to prevent contact with the bed coverings.
3.    Side rails (E0305, E0310) are covered when they are required by the patient's condition and they are an integral
      part of, or an accessory to, a covered hospital bed.
4.    Safety enclosures (E0316) are covered when they are required by the patient's condition and they are an integral
      part of, or an accessory to, a covered hospital bed.
5.    If a patient's condition requires a replacement innerspring mattress (E0271) or foam rubber mattress (E0272) it
      will be covered for a patient owned hospital bed.

Items that are not covered

Including but not limited to the following:
1. Beds-oscillating and lounge beds, bed baths and lifters, bedboards, tables and other bed accessories
2. Positioning rolls or pillows
3. Environmental products -e.g. hypoallergenic bedding, linens
4. Heat and massage foam cushion pads
5. Massage devices
6. Orthopedic mattresses
7. Waterbeds
8. Other convenience reasons, such as because member is unable to walk upstairs to bedroom.
9. Ordinary beds
10. Enclosed beds such as but not limited to Vail, Posey or Pedicraft; pediatric hospital grade fully enclosed crib
     (E0300). These items are considered custodial care equipment
11. Orthopedic beds, including the mattresses
12. Overbed table (E0274, E0315)

Definitions
Fixed Height Hospital Bed (E0250, E0251, E0290, and E0291) is one with manual head and leg elevation
adjustments but no height adjustment.
Variable Height Hospital Bed (E0255, E0256, E0292, E0293) is one with manual height adjustment and with
manual head and leg elevation adjustments.
Semi-electric hospital bed (E0260, E0261, E0294, and E0295) is one with manual height adjustment electric head
    and leg elevation adjustments.
Total electric hospital bed (E0265, E0266, E0296, E0297) is one with electric height adjustment and with electric
    head and leg elevation adjustments.
Heavy Duty Extra Wide Hospital Bed (E0301, E0303) is capable of supporting a patient who weighs more than 350
    pounds, but no more than 600 pounds.
Extra Heavy-Duty Hospital Bed (E0302, E0304) is capable of supporting a patient who weighs more than 600
    pounds.
Ordinary Bed is one which is typically sold as furniture. It may consist of a frame, box spring and mattress. It is a
    fixed height and may or may not have head or leg elevation adjustments.
Safety Enclosure (E0316) is used to prevent a patient from leaving the bed.


Products
Consult your plan documents (Membership Contract, Summary Plan Description [SPD], Evidence of coverage [EOC]
or similar plan document) to determine governing contractual provisions, including exclusions and limitations relating
to your specific plan. These guidelines apply to most, but not all, plans offered by HealthPartners. We strive to ensure
that the contents of this site are correct and complete, but to verify your benefits, please check your plan documents,

hospital bed FINAL 4-17-09.doc
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or contact Member Services. In the event of a conflict between your specific plan documents and this general
information, the plan documents will govern. These coverage criteria may not apply to Medicare Products if Medicare
requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare
coverage policy contact Member Services at 952-883-7979 or 800-233-9645.

Vendor - Full Line
      •     Items must be received from a contracted vendor who carries a full line of DME equipment.
      •     Full line vendors provide a wide range of equipment and supplies, such as hospital beds, aids for ambulating
            and toileting, phototherapy lights, wheelchairs, custom seating devices, monitors, pumps, oxygen and etc.

Number D026 & D027-02; Approved Medical Director Committee 01/01/94; Revised 3/1/04, 4/1/09; Annual Review
8/1/06, 8/1/07, 7/1/08, 4/1/09.

Bibliography
1. NCD for Hospital Beds (280.7)
     http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=280.7&ncd_version=1&basket=ncd%3A280%2E7%3A1%3AHospital+Beds
2. LCD for Hospital Beds And Accessories (L11572)- 1/1/08 -
     http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=11572&lcd_version=32&show=all
3. Article for HOSPITAL BEDs And Accessories - Policy Article - Effective January 2008 (A37079) -
     http://www.cms.hhs.gov/mcd/viewarticle.asp?article_id=37079&article_version=15&basket=article%3A37079%3A15%3AHospit
     al+Beds+And+Accessories+%2D+Policy+Article+%2D+Effective+January+2008%3ADME+MAC%3ANoridian+Administrative+
     Services+%2819003%29




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