Indications and Limitations of Coverage and/or Medical Necessity

For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements. For the items addressed in this medical policy, the criteria for "reasonable and necessary" are defined by the following indications and limitations of coverage and/or medical necessity.

For an item to be covered by Medicare a written signed and dated order must be received by the supplier before a claim is submitted. If the supplier bills for an item addressed in this policy without first receiving the completed order, the item will be denied as not medically necessary.

A fixed height hospital bed (E0250, E0251, E0290, E0291, and E0328) is covered if one or more of the following criteria (1-4) are met:

The patient has a medical condition which requires positioning of the body in ways not feasible with an ordinary bed. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed, or

The patient requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain, or The patient 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 and ruled out, or

The patient requires traction equipment, which can only be attached to a hospital bed.

A variable height hospital bed (E0255, E0256, E0292 and E0293) is covered if the patient meets one of the criteria for a fixed height hospital bed and requires a bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair or standing position.

A semi-electric hospital bed (E0260, E0261, E0294, E0295, and E0329) is covered if the patient 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.

A heavy duty extra wide hospital bed (E0301, E0303) is covered if the patient meets one of the criteria for a fixed height hospital bed and the patient's weight is more than 350 pounds, but does not exceed 600 pounds.

An extra heavy-duty hospital bed (E0302, E0304) is covered if the patient meets one of the criteria for a hospital bed and the patient's weight exceeds 600 pounds.

A total electric hospital bed (E0265, E0266, E0296 and E0297) is not covered; the height adjustment feature is a convenience feature. Total electric beds will be paid as the least costly medically appropriate alternative for the comparable semi-electric bed (E0260, E0261, E0294 and E0295).

For any of the above hospital beds (plus those coded E1399 - see Policy Article Coding Guidelines), if documentation does not support the medical necessity of the type of bed billed, payment will be based on the allowance for the least costly medically appropriate alternative.

If the patient does not meet any of the coverage criteria for any type of hospital bed it will be denied as not medically necessary.

Price Sheet(s)

Bariatric Products

Homecare Beds List

Glossy Sell Sheet

Product Comparison

Features

# Split-spring design for easy home delivery and set-up

# 675 lbs patient weight capacity 750 lbs total weight capacity

# Integrated battery backup, bed ends, and half rails standard

# Two locking casters on the head section and two steering lock casters on the foot section

# Two high-low motors, one on the head section and one on the foot section



Specification

Bed Height: min. 15.5" - max. 29.5"

Sleep Surface: Length - 80" - 88" Width - 39", 42" - 48"

Shipping Product Weight: 465 lbs.

Warranty: Frame / Structure: 5 years Mechanical / electrical: 1 year



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Bariatric Bed Package - The BAR750 Bariatric Bed is a heavy-duty full-electric bed frame capable of supporting up to 750 pounds. The bed expands from 39" wide to a full 48" and from 80" in length to 88". ... more



* MSRP - Manufacturer's Suggested Retail Price does not include optional equipment and accessories that may be available for this product.

** This information is not intended to be, nor should it be considered billing or legal advice. Providers are responsible for determining the appropriate billing codes when submitting claims to the Medicare Program and should consult an attorney or other advisor to discuss specific situations in further detail.