Hospital Beds and Accessories

Number: 0543

Table Of Contents

Policy

Scope of Policy

This Clinical Policy Bulletin addresses hospital beds and accessories.

1. Medical Necessity

   Aetna considers hospital beds and accessories medically necessary durable medical equipment (DME) according to the criteria set forth below.

   1. Hospital Beds

      1. Aetna considers hospital beds medically necessary DME for members who meet any of the following criteria:

         1. The member's condition requires positioning of the body (e.g., to alleviate pain, promote good body alignment, prevent contractures, or avoid respiratory infections) in ways not feasible in an ordinary bed; or
         2. The member's condition requires special attachments (e.g., traction equipment) that can only be attached to a hospital bed cannot be fixed and used on an ordinary bed; or
         3. The member 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 and wedges must have been tried and failed. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed.

         A fixed height hospital bed is one with manual head and leg elevation adjustments but no height adjustment.

      2. A semi-electric hospital bed is considered medically necessary if the member 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 semi-electric bed is one with manual height adjustment and with electric head and leg elevation adjustments.
      3. A heavy duty extra wide hospital bed is considered medically necessary if the member meets one of the criteria for a fixed height hospital bed and the member's weight is more than 350 pounds, but does not exceed 600 pounds. Heavy duty hospital beds are hospital beds that are capable of supporting a member who weighs more than 350 pounds, but no more than 600 pounds.
      4. An extra heavy-duty hospital bed is considered medically necessary if the member meets one of the criteria for a hospital bed and the member's weight exceeds 600 pounds. Extra heavy-duty hospital beds are hospital beds that are capable of supporting a member who weighs more than 600 pounds.
      5. A total electric hospital bed is considered medically necessary if the member meets one of the criteria for a fixed height bed and either:
         
         
         1. Requires frequent changes in body position and/or has an immediate need for a change in body position; or
         2. Meets criteria for a variable height feature outlined below.

         A total electric bed is one with electric height adjustment and with electric head and leg elevation adjustments.

      6. For clinical policy on air-fluidized beds, see CPB 0430 - Pressure Reducing Support Surfaces.

   2. Mattresses

      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.

      If a member's condition requires a replacement innerspring mattress or foam rubber mattress, it will be considered medically necessary for a member-owned hospital bed.

      For clinical policy on specialized pressure-reducing support surfaces, see CPB 0430 - Pressure Reducing Support Surfaces.

   3. 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:

      1. Severe arthritis and other injuries to lower extremities (e.g., fractured hip, where the variable height feature is necessary to assist the member to ambulate by enabling the member to place his or her feet on the floor while sitting on the edge of the bed); or
      2. Severe cardiac conditions, where the member is able to leave the bed, but who must avoid the strain of “jumping” up and down; or
      3. Spinal cord injuries (including quadriplegic and paraplegic members), multiple limb amputees, and stroke members, where the member is able to transfer from a bed to a wheelchair, with or without help; or
      4. Other severely debilitating diseases and conditions, if the member requires a bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair, or standing position.

      A variable height hospital bed is one with manual height adjustment and with manual head and leg elevation adjustments.

   4. 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.

   5. 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:

      1. Member can operate the controls and cause the adjustments, and
      2. Member has a condition that requires frequent changes in body position and/or where there may be an immediate need for a change in body position (i.e., no delay can be tolerated).

      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.

   6. Side Rails, Safety Enclosures, and Safety Beds

      1. Aetna considers bedside rails for beds medically necessary DME only when the member's condition requires them and they are an integral part of, or an accessory to, a medically necessary hospital bed. Examples of conditions where bedside rails may be considered medically necessary include members with seizures, vertigo, disorientation, and neurological disorders.
      2. Aetna considers safety enclosures for hospital beds (e.g., safety frame, canopy, or enclosure used in conjunction with a hospital bed) medically necessary DME when all of the following criteria are met:
         
         
         1. The member’s medical or behavioral condition (see Appendix) creates a clinically significant risk of falls or unassisted bed‑exit, including climbing or attempting to climb out of bed; and
         2. The safety enclosure is integral to, or functions as an accessory of, a medically necessary hospital bed that already meets coverage criteria; and
         3. The primary purpose of the safety enclosure is to address a medical need, not to provide general safety, comfort, or convenience; and 
         4. The documentation requirements have been met (see Appendix).

         Note: Most standard Aetna benefit plans specifically exclude coverage of safety items. See Policy Limitations and Exclusions for additional information.
         

      3. The use of safety enclosure beds and/or accessories solely for the prevention of nocturnal roaming is considered not medically necessary.
      4. Safety beds or enclosure bed systems (e.g., SleepSafe Beds, Beds by George such as Dream and Haven series, Cubby Bed, Posey Bed Enclosure System) are considered non-covered stand-alone safety items, not hospital beds or hospital bed accessories. These items do not meet Aetna's definition of covered DME. See Policy Limitations and Exclusions and CPB 0623 - Safety Items for additional information.

   7. Pediatric Hospital Crib

      Aetna considers a pediatric hospital crib medically necessary when the child meets criteria for any of the afore-mentioned hospital beds.

   8. Bed Accessories

      The following bed accessories are considered medically necessary DME according to the criteria set forth below:

      • Bed cradles – bed blanket cradles are considered medically necessary for members with acute gouty arthritis, burns, decubiti, or diabetic ulcer, when necessary to prevent contact with bed coverings.
      • Bed pans (autoclavable hospital type) – reusable, autoclavable bed pans are considered medically necessary if member is bed-confined.
      • Trapeze equipment – trapeze bars are considered medically necessary if the member is bed-confined and needs a trapeze bar to sit up because of respiratory conditions, to change body position for other medical reasons, or to get in and out of bed.  An “attachable” trapeze bar is not covered when used on a ordinary (non-hospital) bed.
      • Heavy duty trapeze equipment is considered medically necessary if the member meets the criteria for regular trapeze equipment and the member's weight is more than 250 pounds.
      • Urinals – urinals are considered medically necessary for bed-confined members.

   9. Hospital Bed Repairs

      The following are repair units of service allowances that are considered medically necessary for common repairs to hospital beds (NHIC, 2009).

      Table: Hospital Bed Repair Allowances

      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.

2. Experimental, Investigational, or Unproven

   Aetna considers the following experimental, investigational, or unproven:

   1. Beds that provide kinetic therapy or continuous lateral rotation therapy (e.g., Kinetic Therapy Triadyne Bed, Hill-Rom TotalCare SpO2RT) for prevention or treatment of pressure sores; beds that provide kinetic therapy or continuous lateral rotation therapy for long-term use outside of the acute-care hospital setting for preventing and treating pulmonary complications because the effectiveness of these beds is limited to use in critically ill patients in the acute-care hospital setting;
   2. Beds that provide vibration therapy or percussion therapy for preventing and treating pulmonary complications related to immobility;
   3. Courtney Bed for children with autism and special needs;
   4. Enclosure Beds and Frame/Canopy Beds: The Vail Enclosure Bed (Vail Products, Inc., Toledo, OH), a padded bed that is completely enclosed with netting because the U.S. Food and Drug Administration has determined that this device poses significant safety risks;
   5. Turning bed for the prevention of pneumonia and bedsores.

3. Policy Limitations and Exclusions

   1. Side rails and safety enclosures for beds are considered safety features; under most benefit plans, safety items are excluded from coverage. Under benefit plans with this exclusion, bedside rails and safety enclosures are excluded from coverage unless they are an integral part of a medically necessary bed.
   2. Powered Chair Conversion Feature: Electric chair positioning features are not covered since they are considered convenience features. The TotalCare Bariatric Bed is an example of a bed with an electric chair positioning feature.
   3. Ordinary (Non-Hospital) Beds: 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.
   4. Aetna does not cover power or manual lounge beds because they are a comfort or convenience item. 

      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:

      • Adjust-A-Sleep Adjustable Bed
      • Adjustable firmness/support mattresses (e.g., Select Comfort/Sleep Number Bed)
      • Craftmatic Adjustable Bed
      • Electropedic Adjustable Bed
      • Sealy Posturpedic Bed
      • Simmons Beautyrest Adjustable Bed
      • Visco-elastic or memory foam mattresses (e.g., Tempur-Pedic)
      • Waterbed.
   5. 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.
   6. Enclosure Beds and Frame/Canopy Beds: Most plans exclude coverage of safety beds (SleepSafe Beds), enclosure beds (e.g., Cubby Bed, 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.
   7. 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:
      
      
      • Bed baths (a.k.a. Schmidt bath)
      • Bed boards (i.e., board inserted between bed spring and mattress to give extra support)
      • Bed elevation blocks (i.e., blocks to elevate the head or foot of bed)
      • Bed lifters (i.e., bed elevators) (e.g., Burke bed elevator)
      • Bed railing pads (i.e., protection over bed railing)
      • Bed spectacles (used for reading while lying flat in bed)
      • Bed trays/reading tables
      • Call switches (i.e., device to summon help)
      • Foot boards (i.e., board at the end of the bed)
      • Gatch boards (i.e., type of bed board)
      • Lap boards (i.e., board used on lap as a table or desk)
      • Overbed tables (e.g., Able table)
      • Standard beds and mattresses made of allergy-free materials.

   8. Limb restraints (leg restraints, limb holders, and wrist restraints) do 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.

   Consistent with DME MAC policy:

   Treating practitioner means physician (MD or DO) or physician assistant, nurse practitioner, or clinical nurse specialist. A prosthetist, orthotist, orthotic fitter, pedorthotist, physical therapist, or occupational therapist is not considered a treating practitioner.

   A new prescription from the treating practitioner is required each time a new device or repair is requisitioned.

   There must be sufficient medical information included in the medical record to demonstrate that all applicable coverage criteria are met.

   Consistent with DME MAC policy:

   Supplier prepared statements and physician attestations by themselves do not provide sufficient documentation of medical necessity, even if signed by the ordering physician.

   "Neither a practitioner’s order, nor a supplier-prepared statement, nor a practitioner’s attestation by itself provides sufficient documentation of medical necessity, even though it is signed by the treating practitioner or supplier. There must be information in the member’s medical record that supports the medical necessity for the item and substantiates the information on a supplier-prepared statement or treating practitioner’s attestation (if applicable)."

   "Forms are subject to corroboration with information in the medical record."

   Records from suppliers or healthcare professionals with a financial interest in the claim outcome are not considered sufficient by themselves for the purpose of determining that an item is reasonable and necessary. 

   Consistent with DME MAC policy:

   A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted.  If the supplier bills for an item addressed in this policy without first receiving a completed SWO, the claim shall be denied as not medically necessary.

   The SWO must contain all the following elements:

   • Member's name or identification number
   • Order date
   • General description of the item
     
     
     • The description can be either a HCPCS code, a HCPCS code narrative, or a brand name/model number
     • In addition to the description of the base item, the SWO must include all concurrently ordered options, accessories or additional features that are separately billed or require an upgraded code (List each separately).
     • For supplies - In addition to the description of the base item, the order/prescription must include all concurrently ordered supplies that are separately billed (List each separately)
       
       
   • Each item or service requested must individually list the HCPCS code (Procedure code) and quantity to be dispensed
   • Treating practitioner name and national provider identifier (NPI)
   • Treating practitioner's signature.

4. Related Policies

   • CPB 0430 - Pressure Reducing Support Surfaces
   • CPB 0623 - Safety Items

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.

Durable Medical Equipment (DME) includes reusable medical devices prescribed to manage a patient’s ongoing clinical needs, and hospital beds represent a major DME category due to their role in positioning, safety, and medical management. Hospital beds may include a variable‑height feature to facilitate safe transfers and reduce fall risk; built‑in weight scales for non‑ambulatory patients requiring precise fluid or weight monitoring; and electric-powered adjustments that allow motorized control of the head, foot, and overall bed height for respiratory optimization, post‑operative care, or pressure injury prevention. Safety components such as side rails and safety closures help prevent falls or unsafe exits, while enclosed safety beds provide a controlled, protective environment for individuals—often pediatric or cognitively impaired—who require enhanced containment to prevent injury. Pediatric hospital cribs offer age‑appropriate, medically equipped enclosures for infants and young children requiring hospital‑level safety. Mattresses and support surfaces may include standard, foam, or advanced pressure‑redistribution technologies based on the patient’s risk for pressure injuries. Bed accessories, such as trapeze bars, assist rails, and padding, support repositioning, mobility, and overall safe use of the hospital bed.

The U.S. Centers for Medicare & Medicaid Services (CMS) define DME as equipment which, according to 42 CFR §414.202:

• Can withstand repeated use;
• Effective with respect to items classified as DME after January 1, 2012, has an expected life of at least 3 years;
• Is primarily and customarily used to serve a medical purpose;
• Generally, is not useful to a person in the absence of illness or injury; and
• Is appropriate for use in a patient’s home.

Medicare National Coverage Determination (NCD) 280.7 outlines the indications and limitations for hospital bed coverage, requiring a physician's prescription and any additional documentation deemed necessary by the Medicare Administrative Contractor (MAC), such as medical records and physician reports, to establish medical necessity. Coverage is warranted if the patient's condition necessitates body positioning to alleviate pain, promote good body alignment, prevent contractures, or avoid respiratory infections in ways not feasible with an ordinary bed, or if special attachments are required that cannot be used with a standard bed. The prescription must accompany the initial claim and detail the patient's medical condition (e.g., cardiac disease, chronic obstructive pulmonary disease, quadriplegia, or paraplegia) along with the severity and frequency of symptoms necessitating the hospital bed. In well-documented cases, the MAC may determine that a variable height feature of a hospital bed is medically necessary for conditions such as severe arthritis or lower extremity injuries, severe cardiac conditions, spinal cord injuries, or other debilitating diseases if it assists the patient in ambulating. Electric powered adjustments for raising and lowering the head and foot of the bed may be covered if the patient's condition requires frequent position changes and they can operate the controls, with exceptions for spinal cord injury and brain-damaged patients. Additionally, bed side rails or safety enclosures may be covered if they are integral to or an accessory of the covered hospital bed, provided they are required by the patient's condition.

Enclosure beds, also known as safety beds, are designed with padded walls and mesh canopies to create secure sleep environments for minimize the risk of self-injury. However, there are evidence‑based concerns about enclosed safety beds which center on the lack of high‑quality clinical evidence, their use as protective or restraint‑like devices, and the absence of guideline support for medical indications. The Medicaid Evidence‑Based Decisions Project (Dickson et al., 2024) reports that research on enclosed beds is "extremely limited," with only one tangential randomized trial showing no improvement in agitation or clinical outcomes, and notes that enclosed beds are frequently used to prevent climbing, wandering, or injury, functioning more as environmental safety or containment devices than medical treatment. Clinical guidelines do not recommend enclosed beds for managing sleep disturbances, wandering, or behavioral issues in neurologic or developmental conditions, instead advising behavioral interventions and environmental modifications, underscoring concerns that enclosed beds may operate as restraint alternatives without evidence of therapeutic benefit.

Dickson et al. (2024) assessed the documentation requirements for enclosed beds, Despite the increasing demand for these beds—driven by rising ASD prevalence, pandemic-related sleep disruptions, and targeted marketing—evidence supporting their effectiveness remains limited. A single randomized controlled trial suggested that while enclosed beds may be viewed as a more humane alternative to standard restraints, they did not show significant improvements in agitation or medication use. Furthermore, clinical guidelines do not recommend enclosed beds for managing sleep issues or fall risks, instead advocating for behavioral therapies and environmental modifications. The potential misuse of these beds as restraints raises ethical concerns, as caregivers may prioritize their own convenience over the child's autonomy. To address this, Medicaid programs emphasize that enclosed beds should not be used for restraint or discipline and require proof of medical necessity, including prior attempts to address underlying behavioral issues. Strategies to prevent misuse include limiting their use to nighttime and ensuring design features that allow for visibility and access. Additionally, adverse events associated with enclosed beds, such as structural failures and serious injuries, underscore the need for caution. As requests for these beds continue to rise, it is essential for policymakers to implement tracking programs to collect data on outcomes and adverse events, develop standardized review processes, and ensure that children who genuinely need these beds can access them while safeguarding against potential harm. Future research should prioritize distinguishing between medical necessity and convenience, ultimately guiding evidence-based policymaking in this area.

Turning Bed

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 whether 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 the 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 the 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 the 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 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".

Appendix

Safety Enclosures for Hospital Beds

Documentation requirements includes all of the following:

• Qualifying diagnosis (must include one of the following):

  • Traumatic brain injury (TBI) with cognitive or behavioral impairment
  • Cerebral palsy (moderate to severe) with unsafe or uncontrolled movements
  • Developmental delay/intellectual disability with impaired judgment or unsafe elopement behaviors
  • Seizure disorder (daily or uncontrolled) posing risk of falling from the bed or self‑injury during nocturnal events
  • Neurological or movement disorder causing involuntary or perpetual movements resulting in injury risk
  • Severe behavioral disorder characterized by self‑injury, violent behavior, or unsafe elopement, posing immediate danger to the member; and
    
• Description of specific safety-related need for the enclosure (e.g., self-injurious behaviors, uncontrolled seizure activity resulting in falling out of bed); and
• Documentation of prior injuries or unsafe mobility events (e.g., falls, unsafe elopement, self-harm); and
• Behavioral or medical treatment optimization
  
  
  • If applicable, behavioral conditions have been addressed, interventions have been attempted without success, and medications have been optimized or deemed inappropriate
  • For seizure‑related conditions, medications have been optimized or deemed inappropriate; and
    
    
• Less‑restrictive alternatives have been trialed without success (e.g., bed rail protectors, mattress on floor, increased caregiver monitoring, alarm systems, removal of environmental hazards); and
• Duration and intended use (e.g., temporary, nighttime only); and
• Bed canopy allows visualization of the member.

Source: Dickson et al., 2024

The items in Column 2 are included in the allowance for the corresponding item in Column 1 when provided at the same time:

When mattress or bedside rails are provided at the same time as a hospital bed, use the single code that combines these items.

References