Hospital Beds
Overview
Hospital beds are used for positioning patients.
Eligible Providers
The following providers are eligible to provide hospital beds:
TPL and Medicare
Providers must meet any provider criteria, including accreditation, for third-party insurance or for Medicare to assist members for whom Minnesota Health Care Programs (MHCP) is not the primary payer.
MHCP quantity limits and thresholds apply to all members unless only Medicare coinsurance or deductible is requested.
Eligible Members
Hospital beds are covered for eligible Medical Assistance and MinnesotaCare members who meet the medical necessity criteria.
Covered Services
Fixed-height manual hospital beds
Codes: E0250, E0251, E0290, E0291
Covered for members with one of the following:
Variable-height manual hospital beds
Codes: E0255, E0256, E0292, E0293
Covered for members who meet criteria for a fixed-height manual hospital bed and require one of the following criteria:
Semi-electric hospital beds
Codes: E0260, E0261, E0294, E0295
Covered for members who meet criteria for a fixed-height manual hospital bed and require one of the following criteria:
Total electric hospital beds
Codes: E0265, E0266, E0296, E0297
Covered for members who meet criteria for a hospital bed and both of the following criteria:
Bariatric, extra-heavy duty, extra wide hospital beds
Codes: E0301-E0304
Covered for members 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.
Coverage may be considered for members with daily seizure activity, uncontrolled movement disorder, or a medically necessary condition putting the member at significant risk for injury in a standard bed. Requests for a manual, semi-electric, or total electric bed must meet the criteria for the type of hospital bed requested.
Pediatric hospital beds
Codes: E0328-E0329
Covered for members 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 with footboard and side rails up to 24 inches above the spring. The bed must be reasonably expected to meet the member’s needs for at least five years.
Enclosed beds
Codes: E0316 (enclosure), E0300 (hospital-grade enclosed crib), E1399 (Enclosed bed manufactured as a unit)
Enclosed beds are considered medically necessary and the least costly alternative only in the most extreme conditions due to the restrictive nature of the beds and the confinement they entail. Enclosed beds may be fully or partially enclosed. All requests for enclosed beds and accessories require an evaluation from an occupational therapist or a behavioral therapist that works directly with the member.
Based on advice from medical consultants, MHCP considers an enclosed bed medically necessary when the member is cognitively impaired and mobile if their unrestricted mobility demonstrates significant risk for serious injury, not just a possibility of injury. Even then, it must be shown that other, less costly methods have been attempted and have failed to effectively address the problem.
Generally, such confinement is not medically necessary nor the least costly way of managing seizures or behaviors such as head banging, rocking, or similar. Issues of sensory deprivation and the potential for overuse must also be addressed in this process.
Coverage will be considered for members 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).
The member must meet the following criteria:
Documentation must show that you have tried or considered, and rejected less costly alternatives, including any of the following (not all-inclusive):
MHCP believes there is no clear-cut medical justification for enclosed beds. The real need is to proactively address with intervention the underlying medical or behavioral issues that give rise to the risk of harm.
Enclosed bed options and accessories
Enclosed bed options and accessories are covered if they are medically necessary and address a specific medical need of the member. The following list of options and accessories is not all-inclusive; many additional options and accessories may be covered if medically necessary.
Replacement mattress or bed rails
Codes: E0271-E0272 (mattress), E0305. E0310 (bed rails)
Covered when used with a patient-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 authorization 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 MN–ITS. For X12 batch submission, refer to the Minnesota Uniform Companion Guides. Use modifiers NU and U3.
Typically Noncovered Services
Some services are typically not covered but may be covered in certain situations. Refer to criteria under Typically Noncovered Services in the Equipment and Supplies section of the MHCP Provider Manual.
Refer to information under the Noncovered Services heading in the Billing the Member (Recipient) section of the MHCP Provider Manual to review the conditions required to bill the member.
Authorization
Submit authorization request and required documentation to the Medical Review Agent.
Hospital Bed Authorization and Documentation Requirements
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 under Covered Services in the Fixed-height manual hospital beds subsection. |
Semi-electric hospital beds | Required after three 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 member’s 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 member that justifies a heavy-duty hospital bed. Authorization requests for a member with daily seizures, uncontrolled movement disorder, or a medically necessary condition must include the history and nature of the seizure, movement disorder, or condition, and document the significant risk of injury in a standard 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 member’s current age, height and weight and expected growth. |
Enclosed beds | Required | Complete both the Enclosed Medical Bed Authorization (DHS-4370) (PDF) and the Minnesota Health Care Programs Authorization Form (DHS-4695) (PDF). 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 member’s mobility, documentation of the specific risk from unrestricted bedtime mobility, the member’s history of 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. List all accessories and options that are not included with a standard enclosed bed, as determined by the manufacturer, on separate lines on the authorization request. List each item by HCPCS code, appropriate modifier, quantity, with the charge and medical necessity documentation for all nonstandard items. |
Billing
Providers are responsible to coordinate services. Refer to the Billing Policy Overview section of Provider Basics for general billing information.
Bill using MN–ITS 837P Professional. Refer to the Billing for Durable Medical Equipment, Medical Supplies, Prosthetics and Orthotics, and Augmentative Devices MN–ITS User Manual for general billing requirements and guidance when submitting claims.
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