Hospital Beds - DME.HC.111.A

Covered: hospital beds (fixed, variable‑height, semi‑electric, total‑electric, heavy‑duty/extra heavy‑duty), air‑fluidized beds, and positioning cushions when the member meets the policy’s clinical criteria; items not meeting criteria are excluded. Key requirements: specific documented indications are required per bed type (fixed: one listed indication; variable: BOTH need for different transfer height AND ≥1 clinical need; semi‑electric: BOTH frequent/urgent repositioning AND ≥1 clinical need; total‑electric: ALL criteria—frequent repositioning, electric height for independent transfers AND ≥1 clinical need), weight thresholds for bariatric beds (>350–600 lbs; >600 lbs), and stringent air‑fluidized rules (stage 3–4 ulcers, bedridden/chair‑bound, would require institutionalization, one month of failed conservative care with specified treatments, caregiver availability/training, weekly evaluation, monthly recertification and 30‑day rental limits).

"Fixed-height hospital bed is medically necessary when one of the following applies: The individual requires body positioning that is not feasible with a standard bed"