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

Hospital Beds:

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 not 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 or wedges must have been considered.

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.

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.

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:

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.

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:

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.

Side Rails:

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:

• Adjust-A-Sleep Adjustable Bed
• Adjustable firmness/support mattresses (e.g., Select Comfort)
• Craftmatic Adjustable Bed
• Electropedic Adjustable Bed
• Simmons Beautyrest Adjustable Bed
• Visco-elastic or memory foam mattresses (e.g., Tempur-Pedic)
• Waterbed.

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.

Enclosure 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) 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.

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 bars -- 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 non-hospital bed.
• Urinals -- urinals are considered medically necessary for bed-confined members.

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:

• 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

Note: The following bed accessory does not meet the requirement of durability for coverage as DME:

• Limb restraints (leg restraints, limb holders, and wrist restraints).

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).

One unit of service is equal to 15 mins.  Units of service include basic troubleshooting and problem diagnosis.

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.