Beds and Mattresses – Commercial and Individual Exchange Medical Policyopen_in_new

Covers medically necessary hospital beds, specialty beds, and support surfaces (preventive and therapeutic) and—only when strict criteria are met—safety enclosures (HCPCS E0316); excludes items not meeting InterQual® criteria or member plan limits and some support services (e.g., sheepskin pads). Coverage requires meeting InterQual® medical-necessity criteria with supporting medical-record documentation, and safety enclosures specifically require a qualifying diagnosis (cognitive impairment or severe behavioral disorder), medications optimized or contraindicated, documented safety risks, and trial/failure or contraindication of less-intensive alternatives.

"Hospital beds and accessories are proven and medically necessary in certain circumstances. For medical necessity clinical coverage criteria, refer to the InterQual® CP: Durable Medical Equipment: S..."

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