Aetna considers hospital beds and accessories medically necessary durable medical equipment (DME) according to the criteria set forth below.
Aetna considers hospital beds medically necessary DME for members who meet any of the following criteria:
A hospital bed is one with manual head and leg elevation adjustments. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed.
For clinical policy on air-fluidized beds, see CPB 0430 - Pressure Reducing Support Surfaces.
Aetna considers mattresses medically necessary DME only where the hospital bed is medically necessary. Note: A separate charge for replacement mattresses should not be allowed where the hospital bed with mattress is rented.
For clinical policy on specialized pressure-reducing support surfaces, see CPB 0430 - Pressure Reducing Support Surfaces.
Variable Height Feature:
Aetna considers hospital beds with a manual or electric variable height feature medically necessary DME for members who meet the criteria for hospital beds set forth above and who have any of the following conditions:
Powered Chair Conversion Feature:
Electric chair positioning features are not covered since they are considered convenience features. Note: The TotalCare Bariatric Bed is an example of a bed with an electric chair positioning feature.
Built-in Weight Scale:
A hospital bed with a built-in scale is considered medically necessary only for non-ambulatory individuals who require periodic weight measurements.
Electric Powered Hospital Bed Adjustments:
Aetna considers electric powered adjustments to lower and raise head and feet medically necessary DME for members who meet the criteria for hospital beds set forth above and meet both of the following criteria:
Note: Upon medical review, exceptions can be made to criterion 2 in members with spinal cord injury and brain damage.
Examples of brand names of electric hospital beds include the Deluxe Franklin Bed.
Aetna considers bedside rails for beds medically necessary DME only when the member's condition requires them. Examples of conditions where bedside rails may be considered medically necessary include members with seizures, vertigo, disorientation, and neurological disorders.
Note: Side rails for beds are considered safety features; under most benefit plans, safety items are excluded from coverage. Under benefit plans with this exclusion, bedside rails are excluded from coverage unless they are an integral part of a medically necessary bed.
Ordinary (Non-Hospital) Beds:
Note: Ordinary beds do not meet Aetna's definition of covered DME, in that ordinary beds are not primarily medical in nature, are not primarily used in the treatment of disease or injury, and are normally of use in the absence of illness or injury. Please check benefit plan descriptions. An ordinary bed is one that is typically sold as furniture. It consists of a frame, box spring, and mattress. It is a fixed height, and has no head or leg elevation adjustments. An ordinary bed will accommodate most transfers to a chair, wheelchair, or standing position. If needed, it can almost always be adapted to accommodate these transfers. The need for a particular bed height would rarely by itself justify the need for a hospital bed.
Aetna does not cover power or manual lounge beds because they are a comfort or convenience item. Note: In addition, power or manual lounge beds do not meet Aetna's definition of covered DME, in that they are not primarily medical in nature, are not primarily used in the treatment of disease or injury, and are normally of use in the absence of illness or injury. Please check benefit plan descriptions. These beds, like other ordinary beds, are typically sold as furniture. The following are examples of brands of lounge beds that do not fall within the definition of DME:
Institutional-Type Hospital Beds:
Institutional-type hospital beds are inappropriate for home use. These include oscillating beds, springbase beds, circulating beds, cage beds, and stryker frame beds.
Beds that provide kinetic therapy or continuous lateral rotation therapy (e.g., Kinetic Therapy Triadyne Bed, Hill-Rom TotalCare SpO2RT) are considered experimental and investigational for prevention or treatment of pressure sores, because of a lack of evidence in the peer-reviewed medical literature of their effectiveness for that indication (AWMA, 2001; Cullum et al, 2001; Cullum et al, 2004). Beds that provide kinetic therapy or continuous lateral rotation therapy are considered experimental and investigational for long-term use outside of the acute-care hospital setting for preventing and treating pulmonary complications because the published peer-reviewed evidence of the effectiveness of these beds is limited to use in critically ill patients in the acute-care hospital setting.
Beds that provide vibration therapy or percussion therapy for preventing and treating pulmonary complications related to immobility are considered experimental and investigational because of a lack of adequate evidence in the peer-reviewed published medical literature of their effectiveness for this indication.
Pediatric Hospital Crib:
Aetna considers a pediatric hospital crib medically necessary when the child meets criteria for any of the afore-mentioned hospital beds.
Aetna considers turning bed for the prevention of pneumonia and bedsores experimental and investigational because its effectiveness has not been established.
Enclosure Beds and Frame/Canopy Beds:
The Vail Enclosure Bed (Vail Products, Inc., Toledo, OH), a padded bed that is completely enclosed with netting, is considered experimental and investigational because the U.S. Food and Drug Administration has determined that this device poses significant safety risks.
Note: Most plans exclude coverage of enclosure beds (e.g., Posey Bed Enclosure Safety System; Vail Enclosure Bed) or a frame/canopy for use with a hospital bed and limb restraints as they are considered non-covered safety items. Aetna's plans cover medically necessary services and supplies for the "diagnosis, care or treatment" of disease or injury. Although restraints, helmets, safety straps, etc., may prevent injury, they are not considered care or treatment of disease or injury. In addition, such safety items are specifically excluded from coverage. Most medical plans specifically exclude charges for care furnished to provide a safe surrounding, including the charges for providing a surrounding free from exposure that can worsen the disease or injury. Please check benefit plan descriptions.
The following bed accessories are considered medically necessary DME according to the criteria set forth below:
Note: The following accessories do not meet Aetna's definition of covered DME because they are not primarily medical in nature, they are not mainly used in the treatment of disease or injury, and they are normally of use to persons who do not have a disease or injury:
Note: The following bed accessory does not meet the requirement of durability for coverage as DME:
In addition, limb restraints are excluded from coverage in plans that exclude safety items. Most medical plans specifically exclude charges for care furnished to provide a safe surrounding, including the charges for providing a surrounding free from exposure that can worsen the disease or injury. Please check benefit plan descriptions.
Hospital Bed Repairs:
The following are repair units of service allowances that are considered medically necessary for common repairs to hospital beds (NHIC, 2009).
|Hospital Bed Part Being Repaired/Replaced||Allowed Units of Service (UOS)|
|Hospital bed pendant||2|
|Hospital bed headboard/footboard||2|
One unit of service is equal to 15 mins. Units of service include basic troubleshooting and problem diagnosis.Background
This policy is adapted from Medicare Durable Medical Equipment Carrier (DMERC) policy.
Note on Vail Enclosure Bed:
On March 22, 2005, the U.S. Food and Drug Administration (FDA) and the U.S. Department of Justice initiated seizures of all finished Vail 500, 1000, and 2000 Enclosed Bed Systems on the ground that use of these systems poses a public health risk because patients can become entrapped and suffocate, resulting in severe neurological damage or death. The FDA believed the Vail products seized do not meet the Quality System regulations of the Federal Food, Drug and Cosmetic Act and pose significant health risk for consumers. Furthermore, Vail Products failed or refused to furnish material or information to the FDA as required by Medical Device Reporting regulation and the Reports of Corrections and Removals regulation. According to an FDA public health notification, Vail Products, on June 16, 2005, stated that it is permanently ceasing the manufacture, sale and distribution of all Vail enclosed bed systems. Vail Products will no longer be available to provide accessories, replacement parts, or retrofit kits. Additionally, on June 23 and 24, 2005, revised instruction manuals and warning labels were mailed to customers with Vail 500, Vail 1000 or Vail 2000 enclosed bed systems. The revised manuals include new warnings, precautions, and instructions for use. The safety precautions state that, if this bed must continue to be used, they should not be used for persons who are less than 45 inches tall or who weigh less than 46 lbs. According to the revised safety precautions, these beds should not be used in persons who exhibit burrowing behavior; who are violent, aggressive, combative, or suicidal; who have multiple lines, or who have excessive pica eating disorder.
Gentilello et al (1988) noted that the risk of nosocomial pneumonia and atelectasis is high among critically ill immobilized patients. These investigators hypothesized that continuous turning on the kinetic treatment table would reduce their incidence. A total of 65 critically ill patients, immobilized because of head injury or traction, were prospectively randomized for treatment in a conventional bed (n = 38) or the kinetic treatment table (n = 27). Patients were well-matched for baseline demographic and pulmonary risk factors. Patients in the conventional bed group had a higher incidence of cigarette smoking. The combined incidence of significant atelectasis or pneumonia was higher (66 %) in the conventional versus kinetic treatment table (33 %) groups (p < 0.01). Atelectasis, pneumonia, adult respiratory distress syndrome, requirements for ventilator treatment, for PEEP, and for an FIO2 greater than 0.50 were not significantly different, but tended to be higher in the control group. Survival and the incidence of decubitus ulcers were similar.
Delaney et al (2006) examined if kinetic bed therapy reduces the incidence of nosocomial pneumonia and improves outcomes in critically ill mechanically ventilated patients. These investigators searched Medline, EMBASE, CINAHL, CENTRAL, and AMED for studies, as well as reviewed abstracts of conference proceedings, bibliographies of included studies and review articles and contacted the manufacturers of medical beds. Studies included were randomized or pseudo-randomized clinical trials of kinetic bed therapy compared to standard manual turning in critically ill mechanically ventilated adult patients. Two reviewers independently applied the study selection criteria and extracted data regarding study validity, type of bed used, intensity of kinetic therapy, and population under investigation. Outcomes assessed included the incidence of nosocomial pneumonia, mortality, duration of ventilation, and intensive care unit and hospital length of stay. A total of 15 prospective clinical trials were identified, which included a total of 1,169 participants. No trial met all the validity criteria. There was a significant reduction in the incidence of nosocomial pneumonia (pooled odds ratio (OR) 0.38, 95 % confidence interval (CI): 0.28 to 0.53), but no reduction in mortality (pooled OR 0.96, 95 %CI: 0.66 to 1.14), duration of mechanical ventilation (pooled standardized mean difference (SMD) -0.14 days, 95 % CI: -0.29 to 0.02), duration of intensive care unit stay (pooled SMD -0.064 days, 95 % CI: -0.21 to 0.086) or duration of hospital stay (pooled SMD 0.05 days, 95 % CI: -0.18 to 0.27). The authors concluded that while kinetic bed therapy has been purported to reduce the incidence of nosocomial pneumonia in mechanically ventilated patients, the overall body of evidence is insufficient to support this conclusion. There appears to be a reduction in the incidence of nosocomial pneumonia, but no effect on mortality, duration of mechanical ventilation, or intensive care or hospital length of stay. Given the lack of consistent benefit and the poor methodological quality of the trials included in this analysis, definitive recommendations regarding the use of this therapy cannot be made at this time.
Goldhill et al (2007) reviewed the effect of rotational therapy (use of therapeutic surfaces that turn on their longitudinal axes) on prevention and/or treatment of respiratory complications in critically ill patients. Published articles evaluating prophylaxis and/or treatment were reviewed. Prospective randomized controlled trials were assessed for quality and included in meta-analyses. A literature search yielded 15 non-randomized, uncontrolled, or retrospective studies. Twenty prospective randomized controlled trials on rotational therapy were published between 1987 and 2004. Various types of beds were studied, but few details on the rotational parameters were reported. The usual control was manual turning of patients by nurses every 2 hours. One animal investigation and 12 clinical trials addressed the effectiveness of rotational therapy in preventing respiratory complications. Significant benefits were reported in the animal study and 4 of the trials. Significant benefits to patients were reported in 2 of another 4 studies focused on treatment of established complications. Researchers have examined the effects of rotational therapy on mucus transport, intra-pulmonary shunt, hemodynamic effects, urine output, and intra-cranial pressure. Little convincing evidence is available, however, on the most effective rotation parameters (e.g., degree, pause time, and amount of time per day). Meta-analysis suggested that rotational therapy decreases the incidence of pneumonia but has no effect on duration of mechanical ventilation, number of days in intensive care, or hospital mortality. The authors concluded that rotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.
In a systematic reviews of wound care management, Cullum et al (2001) evaluated the clinical effectiveness and cost-effectiveness of: (i) pressure-relieving beds, mattresses and cushions for pressure sore prevention and treatment; (ii) compression therapy for the prevention and treatment of leg ulcers; (iii) low-level laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy for the treatment of chronic wounds. A total of 19 electronic databases, including MEDLINE, CINAHL, EMBASE and the Cochrane Controlled Trials Register (CENTRAL), were searched. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. An expert panel was also consulted. Randomized controlled trials (RCTs) that evaluated these interventions were eligible for inclusion in this review if they used objective measures of outcome such as wound incidence or healing rates. A total of 45 RCTs were identified, of which 40 compared different mattresses, mattress overlays and beds. Only 2 trials evaluated cushions, 1 evaluated the use of sheepskins, and 2 looked at turning beds/kinetic therapy. A total of 24 trials reporting 26 comparisons were included (2 of prevention and 24 of treatment strategies). Four RCTs of laser (for venous leg ulcers), 10 of therapeutic ultrasound (for pressure sores and venous leg ulcers), 12 of electrotherapy (for ischemic and diabetic ulcers, and chronic wounds generally) and 5 of electromagnetic therapy (for venous leg ulcers and pressure sores) were included. Studies were generally small, and of poor methodological quality. The authors concluded that (i) foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure sores in people at risk, as can pressure-relieving overlays on the operating table. One study suggested that air-fluidized therapy may increase pressure sore healing rates, (ii) compression is more effective in healing venous leg ulcers than is no compression, and multi-layered high compression is more effective than single-layer compression. High-compression hosiery was more effective than moderate compression in preventing ulcer recurrence, and (iii) there is generally insufficient reliable evidence to draw conclusions about the contribution of laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy to chronic wound healing. (No conclusion was drawn regarding the turning bed)
In an evidence-based analysis on “Management of chronic pressure ulcers” by the Health Quality Ontario (2009), as well as a National Pressure Ulcer Advisory Panel’s guideline on “Pressure ulcer treatment recommendations” (2009), turning/rotational bed is not mentioned as a management tool.
Furthermore, the Institute for Clinical Systems Improvement’s health care protocol on “Pressure ulcer prevention and treatment protocol” (ICSI, 2012) does NOT mention the use of turning/rotational bed.
Also, an UpToDate review on “Prevention of pressure ulcers” (Berlowitz, 2013) states that “Continuous lateral rotation was originally developed to enhance respiratory function in hospitalized patients, but has been advocated for the prevention and management of pressure ulcers. Continuous lateral rotation is achieved with a mechanized bed that continuously rotates around its longitudinal axis. Observational studies indicate modest improvements in healing rates when continuous lateral rotation is added to an advanced therapy surface. Conceptually, the advantage gained by this automated approach to pressure reduction could be offset by the presence of continuous shearing forces. Technical parameters such as bed rotation frequency and bed tilt angle need to be better defined. Continuous rotation therapy is not likely to replace the need to reposition the patient every two hours, but clearly further study is warranted”.
|CPT Codes / HCPCS Codes / ICD-9 Codes|
|HCPCS codes covered if selection criteria are met:|
|E0250||Hospital bed, fixed height, with any type side rails, with mattress|
|E0251||Hospital bed, fixed height, with any type side rails, without mattress|
|E0255||Hospital bed, variable height, hi-lo, with any type side rails, with mattress|
|E0256||Hospital bed, variable height, hi-lo, with any type side rails, without mattress|
|E0260||Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress|
|E0261||Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress|
|E0265||Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress|
|E0266||Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, without mattress|
|E0271||Mattress, inner spring|
|E0272||Mattress, foam rubber|
|E0275||Bed pan, standard, metal or plastic|
|E0276||Bed pan, fracture, metal or plastic|
|E0280||Bed cradle, any type|
|E0290||Hospital bed, fixed height, without side rails, with mattress|
|E0291||Hospital bed, fixed height, without side rails, without mattress|
|E0292||Hospital bed, variable height, hi-lo, without side rails, with mattress|
|E0293||Hospital bed, variable height, hi-lo, without side rails, without mattress|
|E0294||Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress|
|E0295||Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress|
|E0296||Hospital bed, total electric (head, foot, and height adjustments), without side rails, with mattress|
|E0297||Hospital bed, total electric (head, foot, and height adjustments), without side rails, without mattress|
|E0300||Pediatric crib, hospital grade, fully enclosed, with or without top enclosure|
|E0325||Urinal; male, jug-type, any material|
|E0326||Urinal; female, jug-type, any material|
|E0328||Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard, and side rails up to 24 in. above the spring, includes mattress|
|E0329||Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard, and side rails up to 24 in. above the spring, includes mattress|
|E0910||Trapeze bars (a.k.a. Patient Helper), attached to bed, with grab bar|
|E0911||Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar|
|E0912||Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar|
|E0940||Trapeze bar, free standing, complete with grab bar|
|K0739||Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes|
|HCPCS codes not covered for indications listed in the CPB:|
|E0270||Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress|
|E0305||Bedside rails, half-length (safety item)|
|E0310||Bedside rails, full-length (safety item)|
|E0315||Bed accessory: board, table, or support device, any type|
|E0316||Safety enclosure frame/canopy for use with hospital bed, any type (safety item)|
|E0700||Safety equipment (e.g., belt, harness or vest)|
|E0710||Restraints, any type (body, chest, wrist or ankle)|
|Other HCPCS codes related to the CPB:|
|E0184||Dry pressure mattress|
|E0186||Air pressure mattress|
|E0196||Gel pressure mattress|
|E0197||Air pressure pad for mattress, standard mattress length and width|
|E0277||Powered pressure-reducing air mattress|
|E0301||Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress|
|E0302||Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress|
|E0303||Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress|
|E0304||Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress|
|E0370||Air pressure elevator for heel|
|E0371||Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width|
|E0372||Powered air overlay for mattress, standard mattress length and width|
|E0373||Nonpowered advanced pressure reducing mattress|
|Other ICD-9 codes related to the CPB (too many to list - examples only):|
|330.0 - 337.9||Hereditary and degenerative diseases of the central nervous system|
|340 - 349.9||Other disorders of the central nervous system|
|390 - 459.9||Diseases of the circulatory system|
|711.00 - 716.99||Arthropathy|
|780.33||Post traumatic seizures|
|780.4||Dizziness and giddiness|
|806.00 - 806.9||Fracture of vertebral column with spinal cord injury|
|820.0 - 828.1||Fracture of lower limb|
|885.0 - 887.7||Traumatic amputation of upper limb|
|895.0 - 897.7||Traumatic amputation of lower limb|
|952.00 - 952.9||Spinal cord injury without evidence of spinal bone injury|
|V49.60 - V49.77||Upper or lower limb amputee status|