E0270 — Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For bedside rails/safety enclosures: documentation that member is at risk for falls or climbing out of bed, or has conditions such as seizures, vertigo, disorientation, or neurological disorders that require rails.
- For bed-confined accessories (bed pans, urinals, trapeze): documentation that the member is bed-confined and the clinical reason for the accessory (e.g., need to sit up because of respiratory condition, change body position, or get in/out of bed).
- For replacement mattresses on member-owned hospital beds: documentation that condition requires replacement mattress (innerspring or foam rubber).
- Clinical notes and history supporting ICD-10 diagnoses used (e.g., Z91.81 History of falling) when cited as reason for rails/enclosures.
Key Coverage Criteria
- The member's condition requires positioning of the body (e.g., to alleviate pain, promote good body alignment, prevent contractures, or avoid respiratory infections) in ways not feasible in an ordinary bed.
- The member's condition requires special attachments (e.g., traction equipment) that can only be attached to a hospital bed cannot be fixed and used on an ordinary bed.
- The member 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 must have been considered.)
- Fixed height hospital bed: medically necessary when the member meets any of the general hospital bed criteria above.
- Semi-electric hospital bed: medically necessary if the member meets one of the criteria for a fixed height bed and requires frequent changes in body position and/or has an immediate need for a change in body position (semi-electric = manual height adjustment; electric head and leg elevation).
- Heavy duty extra wide hospital bed: medically necessary if the member meets one of the criteria for a fixed height hospital bed and the member's weight is more than 350 pounds, but does not exceed 600 pounds.
3 Active Policies
DME101.001 — Hospital Beds and Related Equipment
HUMANA-MEDICAL-SUPPLIES-EQUIPMENT-AND-APPLIANCES-DURABLE-MEDICAL-EQUIPMENT-VA-MEDICAID — Medical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - VIRGINIA
AETNA-CPB-0543 — Hospital Beds and Accessories
Related Codes
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