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Minnesota Department of Human Services Provider Manual
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Hospital Beds

Revised: 07-29-2011

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Non-Covered Services
  • Authorization
  • Billing
  • Overview

    Hospital beds are used for positioning patients.

    Eligible Providers

  • • Medical suppliers
  • • Pharmacies
  • • Home health agencies
  • • Indian Health Services
  • • Federally Qualified Health Center
  • • Rural Health Clinic

  • TPL and Medicare

    Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare in order to assist recipients for whom MHCP is not the primary payer.

    MHCP quantity limits and thresholds apply to all recipients unless only Medicare co-insurance or deductible is requested.

    Eligible Recipients

    Hospital beds are covered for eligible MHCP recipients who meet the medical necessity criteria.

    Covered Services

    Fixed height manual hospital beds

    Codes: E0250, E0251, E0290, E0291
    Covered for recipients with one of the following medical conditions:

  • • A medical condition that requires positioning of the body in ways not feasible in an ordinary bed, where pillows or wedges do not meet the recipient’s needs
  • • A medical condition that requires special attachments, such as traction equipment, that cannot be fixed and used on an ordinary bed
  • • A medical condition that requires the head of the bed to be elevated more than 30 degrees, where pillows or wedges do not meet the recipient’s needs

  • Variable height manual hospital beds

    Codes: E0255, E0256, E0292, E0293
    Covered for recipients who meet criteria for a fixed height manual hospital bed and require one of the following criteria:

  • • A bed height different than a fixed height hospital bed to permit transfers in or out of the bed
  • • A change of bed height to enable caregivers(s) to assist with recipient care

  • Semi-electric hospital beds

    Codes: E0260, E0261, E0294, E0295
    Covered for recipients who meet criteria for a fixed height manual hospital bed and require one of the following criteria:

  • • Frequent changes in body position to alleviate pain or address a medical condition
  • • Immediate changes in body position to alleviate pain or address a medical condition

  • Total electric hospital beds

    Codes: E0265, E0266, E0296, E0297
    Covered for recipients who meet criteria for a hospital bed and both of the following criteria:

  • • Require a change of bed height at least once per day to allow a caregiver to assist with recipient care
  • • The caregiver is unable to change the bed height manually, but is able to assist with all necessary cares in bed

  • Bariatric, extra-heavy duty, extra wide hospital beds

    Codes: E0301-E0304
    Covered for recipients who meet criteria for the type of hospital bed requested (manual, semi-electric, total electric) and whose weight is within the capacity limits of the requested bed.

    Pediatric hospital beds

    Codes: E0328-E0329
    Covered for recipients who meet criteria for a manual, semi-electric or total electric hospital bed and who have medical needs best met by a pediatric sized bed. The bed must be reasonably expected to meet the recipient’s needs for at least 5 years.

    Bed Enclosure (Pedicraft, SleepSafe)

    Codes E0316 (enclosure), E0300 (hospital grade enclosed crib), E1399 (Enclosed bed manufactured as a unit)
    Note: As of August 2010, Posey does not market an enclosed bed for home care and does not need to be considered when determining the least costly appropriate alternative.

    This type of bed is considered medically necessary and the least costly alternative only in the most extreme conditions due to the restrictive nature of the bed and the confinement it entails.

    Based on advice from medical consultants, Minnesota Health Care Programs considers an enclosed bed medically necessary when the recipient is cognitively impaired and mobile if his/her unrestricted mobility has resulted in documented injuries sustained as a result of wandering unsupervised. Even then, it must be shown that other, less costly methods have been attempted and have failed to effectively treat the problem.

    Generally, such confinement is not medically necessary nor the least costly way of managing seizures or behaviors such as head banging, rocking, etc. Issues of sensory deprivation and the potential for overuse must also be addressed in this process.

    Coverage will be considered for recipients who have documented evidence of unsafe mobility (climbing out of bed and moving round the home, not just standing at the side of the bed), including mobility that will put the recipient at significant risk for serious injury, not just a possibility of injury.

    The recipient must meet the following criteria:

  • • Diagnosis of one of the following:
  • • Brain injury
  • • Moderate to severe cerebral palsy
  • • Seizure disorder with daily seizure activity
  • • Developmental disability
  • • Severe behavioral disorder
  • • Documentation of a specific risk from unrestricted mobility including
  • • Tonic-clonic type seizures
  • • Uncontrolled perpetual movement related to diagnosis
  • • Self-injurious behavior
  • • Less costly alternatives have been tried or considered and rejected including any of the following (not all-inclusive):
  • • Padding around a regular or hospital bed
  • • Placing the mattress on the floor
  • • Medications to address seizures and / or behaviors
  • • Behavior modification strategies
  • • Helmets for head banging
  • • Removing safety hazards from the recipient’s bedroom and using a child protection device on the door knob
  • • Baby monitors to listen to the recipient’s activity

  • MHCP believes that there is no clear-cut medical justification for the enclosed bed systems. The real need is to proactively address with intervention the underlying medical and/or behavioral issues that give rise to the risk of harm.

    Replacement mattress / bed rails

    Codes: E0271-E0272 (mattress), E0305. E0310 (bed rails)
    Covered when used with a recipient-owned hospital bed.

    When replacing a mattress on a patient-owned heavy duty or bariatric bed, include “bariatric mattress for patient owned bariatric bed” and the PA number or purchase date for the bed if known in the Claim Notes field on the Claim Information tab or in the line item Notes field on the Services tab in MNITS. For X12 batch submitter refer to the Minnesota Uniform Companion Guides. Use modifiers NU and U3.

    Non-Covered Services

  • • Beds which are typically sold as furniture, including adjustable beds that are not manufactured as durable medical equipment
  • • Orthopedic mattresses
  • • Waterbeds
  • • Oscillating and lounge beds
  • • Bed tables and other bed accessories
  • • Bedding or linens, including hypoallergenic bedding
  • • Heat and massage pads
  • • Enclosed beds for recipients with awake caregivers 24 hours per day
  • Authorization

    Submit authorization request and required documentation to the Authorization Medical Review Agent.

    Item

    Authorization Requirements

    Documentation Requirements

    Manual hospital beds

    Not required for rental or purchase

    Documentation in the provider’s files must establish medical necessity as described above

    Semi-electric hospital beds

    Required after 3 months rental and for all purchases

    Authorization requests must document the medical condition that requires a hospital bed, and the frequency of severity of symptoms that require repositioning. Include a description of the recipient’s and/or caregiver’s judgment and ability to operate the bed.

    Total electric hospital beds

    Always required for purchase or rental

    Authorization requests must document the medical condition that requires a hospital bed, and the reason that changes in bed height are required. Include documentation that demonstrates that the caregiver is unable to change the bed height manually, but is able to assist with needed cares and transfers.

    Bariatric / heavy duty hospital beds

    Required

    Authorization requests must document the medical condition that requires a hospital bed, and the weight of the recipient that justifies a heavy duty hospital bed.

    Pediatric hospital beds

    Required

    Authorization requests must document the medical condition that requires a manual, semi-electric or total electric hospital bed, as well as the medical condition that prevents the use of a standard size hospital bed. Include documentation of the recipient’s current age, height and weight and expected growth.

    Enclosed beds

    Required

    Complete both the Information Needed for Authorization Requests for Enclosed Medical Beds (DHS-4370) and the Minnesota Health Care Programs Authorization Form (DHS-4695). Submit completed forms to Authorization Medical Review Agent as instructed on authorization forms. Documentation must include a diagnosis that is directly linked to the need for the enclosed bed, a complete description of the recipient’s mobility, documentation of the specific risk from unrestricted bedtime mobility, the recipient’s history of injuries (or near-injuries) related to bedtime mobility, all less costly and less intrusive alternatives tried or considered and why they were rejected, and all other information requested on the authorization form.

    Billing

  • • Codes E0250, E0255, E0260, E0265, E0303, E0304, E0328, and E0329 include the bed, bed rails and mattress. Do not bill rails (E0305, E0310) or mattress (E0271, E0272) within 180 days of billing these codes.
  • • Codes E0251, E0256, E0261, E0266, E0301, and E0302 include the bed and bed rails. Do not bill rails (E0305, E0310) within 180 days of bill these codes.
  • • Codes E0290, E0292, E0294 and E0296 include the bed and mattress. Do not bill mattress (E0271, E0272) within 180 days of billing these codes.
  • • Use X12 Batch or MN–ITS 837P Professional electronic claim
  • • Report the ordering provider in the Other Provider Types section of the MN–ITS Interactive claim
  • • If the recipient has Medicare, MHCP will pay only the deductible / co-insurance on any item for which Medicare made payment, regardless of any MHCP prior authorization.
  • • If the recipient has Medicare, any items for which Medicare denies payment must meet MHCP coverage and authorization requirements.
  • • Shipping / delivery/ set-up costs are included in the MHCP maximum allowable payment and may not be separately billed to MHCP or the recipient.
  • • Hospital beds are expected to serve the recipient for at least 5 years. If a device is stolen or damaged beyond repair, a replacement device may be covered with authorization.
  • • Refer to Non-Mobility Equipment Repairs for billing requirements for repairs to hospital beds.
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    Updated: 12/16/11 10:28 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 12/16/11 10:28 AM