Clinical Policy Bulletin: Hospital Beds and Accessories
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:
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
The member's condition requires special attachments (e.g., traction equipment) that can not be fixed and used on an ordinary bed; or
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.
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.
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:
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
Severe cardiac conditions, where the member is able to leave the bed, but who must avoid the strain of “jumping” up and down; or
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
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:
Member can operate the controls and cause the adjustments, and
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.
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:
Visco-elastic or memory foam mattresses (e.g., Tempur-Pedic)
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.
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.
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).
Hospital Bed Part Being Repaired/Replaced
Allowed Units of Service (UOS)
Hospital bed pendant
Hospital bed headboard/footboard
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.
CPT Codes / HCPCS Codes / ICD-9 Codes
HCPCS codes covered if selection criteria are met:
Hospital bed, fixed height, with any type side rails, with mattress
Hospital bed, fixed height, with any type side rails, without mattress
Hospital bed, variable height, hi-lo, with any type side rails, with mattress
Hospital bed, variable height, hi-lo, with any type side rails, without mattress
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress
Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress
Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, without mattress
Mattress, inner spring
Mattress, foam rubber
Bed pan, standard, metal or plastic
Bed pan, fracture, metal or plastic
Bed cradle, any type
Hospital bed, fixed height, without side rails, with mattress
Hospital bed, fixed height, without side rails, without mattress
Hospital bed, variable height, hi-lo, without side rails, with mattress
Hospital bed, variable height, hi-lo, without side rails, without mattress
Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress
Hospital bed, total electric (head, foot, and height adjustments), without side rails, with mattress
Hospital bed, total electric (head, foot, and height adjustments), without side rails, without mattress
Urinal; male, jug-type, any material
Urinal; female, jug-type, any material
Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard, and side rails up to 24 in. above the spring, includes mattress
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
Trapeze bars (a.k.a. Patient Helper), attached to bed, with grab bar
Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar
Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar
Trapeze bar, free standing, complete with grab bar
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:
Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress
Pediatric crib, hospital grade, fully enclosed, with or without top enclosure
Bedside rails, half-length (safety item)
Bedside rails, full-length (safety item)
Bed accessory: board, table, or support device, any type
Safety enclosure frame/canopy for use with hospital bed, any type (safety item)
Safety equipment (e.g., belt, harness or vest)
Restraints, any type (body, chest, wrist or ankle)
Other HCPCS codes related to the CPB:
Dry pressure mattress
Air pressure mattress
Gel pressure mattress
Air pressure pad for mattress, standard mattress length and width
Powered pressure-reducing air mattress
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
Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress
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
Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress
Air pressure elevator for heel
Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width
Powered air overlay for mattress, standard mattress length and width
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
Post traumatic seizures
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
The above policy is based on the following references:
U.S. Department of Health and Human Services, Health Care Financing Administration (HCFA). Medicare Coverage Issues Manual §§ 60-9, 60-18. Baltimore, MD: HCFA; 1999.
Australian Wound Management Association (AWMA), Pressure Ulcer Interest Sub-Committee. Clinical Practice Guidelines for the Prediction and Prevention of Pressure Ulcers. West Leederville, Australia: AWMA; 2001.
Cullum N, Nelson EA, Flemming K, Sheldon T. Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess. 2001;5(9):1-221.
McInnes E, Bell-Syer SEM, Dumville JC, et al. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2008;(4):CD001735.
Martin AH. Should continuous lateral rotation therapy replace manual turning? Nurs Manage. 2001;32(8):41-45.
Wang JY, Chuang PY, Lin CJ, et al. Continuous lateral rotational therapy in the medical intensive care unit. J Formos Med Assoc. 2003;102(11):788-792.
Kirschenbaum L, Azzi E, Sfeir T, et al. Effect of continuous lateral rotational therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-term ventilatory care. Crit Care Med. 2002;30(9):1983-1986.
Davis K Jr, Johannigman JA, Campbell RS, et al. The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury. Crit Care. 2001;5(2):81-87.
Staudinger T, Kofler J, Mullner M, et al. Comparison of prone positioning and continuous rotation of patients with adult respiratory distress syndrome: Results of a pilot study. Crit Care Med. 2001;29(1):51-56.
Meyers C, Low L, Kaufman L, et al. Trendelenburg positioning and continuous lateral rotation improve oxygenation in hepatopulmonary syndrome after liver transplantation. Liver Transpl Surg. 1998;4(6):510-512.
Dolovich M, Rushbrook J, Churchill E, et al. Effect of continuous lateral rotational therapy on lung mucus transport in mechanically ventilated patients. J Crit Care. 1998;13(3):119-125.
Basham KA, Vollman KM, Miller AC. To everything turn, turn, turn.... An overview of continuous lateral rotational therapy. Respir Care Clin N Am. 1997;3(1):109-134.
Whiteman K, Nachtmann L, Kramer D, et al. Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients. Am J Crit Care. 1995;4(2):133-139.
Patel UH, Jones JT, Babbs CF, et al. The evaluation of five specialized support surfaces by use of a pressure-sensitive mat. Decubitus. 1993;6(3):28-31, 34, 36-37.
Sahn SA. Continuous lateral rotational therapy and nosocomial pneumonia. Chest. 1991;99(5):1263-1267.
Schimmel L, Civetta JM, Kirby RR. A new mechanical method to influence pulmonary perfusion in critically ill patients. Crit Care Med. 1977;5(6):277-279.
Powers J, Daniels D. Turning points: Implementing kinetic therapy in the ICU. Nurs Manage. 2004;35(5):suppl 1-8.
Priestley MA, Helfaer MA. Approaches in the management of acute respiratory failure in children. Curr Opin Pediatr. 2004;16(3):293-298.
Mullins CD, Philbeck TE Jr, Schroeder WJ, Thomas SK. Cost effectiveness of kinetic therapy in preventing nosocomial lower respiratory tract infections in patients suffering from trauma. Manag Care Interface. 2002;15(8):35-40.
Fischer JA. How to promote pulmonary health with kinetic therapy. Nurs Manage. 2000;31(1):38-40.
Raoof S, Chowdhrey N, Raoof S, et al. Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients. Chest. 1999;115(6):1658-1666.
Marik PE, Fink MP. One good turn deserves another! Crit Care Med. 2002;30(9):2146-2148.
Bahzad MS, Jocelyn R, Chiddok DR, et al. The effect of continuous lateral roation versus conventional critical care bed in the management of acute respiratory distress syndrome. Chest. 2002;122(4):53S-54S.
Stiletto R, Ose C, Folsch C. Positioning therapy in the treatment of severe oxygenation disorders in critically ill patients: Part I - Current status in the practical use of positioning therapy in German ICUs. Results of a randomized, cross-sectional trial. Int J Intensive Care. 2003;1-5.
Pape HC. Is early kinetic positioning beneficial for pulmonary function in multiple trauma patients? Injury. 1998;29(3);219-225.
Pape HC, Regel G, Borgmann W, et al. The effect of kinetic positioning on lung function and pulmonary hemodynamics in posttraumatic ARDS: A clinical study. Injury. 1994; 25(1) 51-57.
Dobson PS, Edbrooke DL, Reilly CS. The role of kinetic therapy in intensive care: The effects of immobilization and some possible solutions. Br J Intensive Care. 1993;3(10);370-374.
Tillett JM, Marmarou A, Agnew JP, et al. Effect of continuous rotational therapy on intracranial pressure in the severely brain-injured patient. Clin Intensive Care. 1993;21(7):1005-1011.
deBoisblanc BP, Castro M, Everret B, et al. Effect of air-supported, continuous, postural oscillation on the risk of early ICU pneumonia in nontraumatic critical illness. Chest. 1993;103(5):1543-1547.
Nelson LD, Choi SC. Kinetic therapy in critically ill trauma patients. Clin Intensive Care. 1992;3:248-252.
Choi SC, Nelson LD. Kinetic therapy in critically ill patients. Combined results based on metaanalysis. J Crit Care. 1992;7(1):57-62.
Hess D, Agarwal NN, Myers CL. Positioning, lung function and kinetic bed therapy. Resp Care. 1992;37(2):181-195.
Sahn S. Continuous lateral rotational therapy and nosocomial pneumonia. Chest, 1991;99(5):1263-1267.
Clemmer TP, Green S, Ziegler B, et al. Effectiveness of the kinetic treatment table for preventing and treating pulmonary complications in severly head-injured patients. Crit Care Med. 1990;18(6):615-617.
Kelley RE, Bell LK, Mason RL. Cost Analysis of kinetic therapy in the prevention of complications of stroke. South Med J. 1990;18(6):615-617.
Castro MS, Everett B, deBoisblanc BP. Positioning patients with hypoxemia: Effect on physiology and outcome. Crit Care Rep. 1990;1(2):234-240.
Fink MP, Helsmoortel CM, Stein KL, et al. The efficacy of an oscillation bed in the prevention of lower respiratory tract infection in critically ill victims if blunt trauma; A prospective study. Chest. 1990;97(1):132-137.
Traver GA, Tyler ML, Hudson LD, et al. Continuous oscillation: Outcome in critically ill patients. J Crit Care. 1995;10(3):97-103.
Murai DT, Grant JW. Continuous oscillation therapy improves the pulmonary outcome of intubated newborns: Results of a prospective, randomized, controlled trial. Crit Care Med. 1994;22(7):1147-1154.
Shapiro MJ, Keegan MJ. Continuous oscillation therapy for the treatment of pulmonary contusion. Am Surg. 1992;58(9):546-550.
U.S. Food and Drug Administration (FDA). FDA asks U.S. Marshals to seize adulterated and misbranded hospital bed systems. FDA Talk Paper. T05-10. Rockville, MD: FDA; March 22, 2005. Available at: http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01347.html. Accessed August 8, 2005.
U.S. Food and Drug Administration (FDA), Center for Devices and Radiological Health (CDRH). FDA Preliminary Public Health Notification: Vail Products Enclosed Bed Systems. Rockville, MD: FDA; updated June 24, 2005. Available at: http://www.fda.gov/cdrh/safety/032505-vail.html. Accessed August 8, 2005.
Powell-Cope G, Baptiste AS, Nelson A. Modification of bed systems and use of accessories to reduce the risk of hospital-bed entrapment. Rehabil Nurs. 2005;30(1):9-17.
NHIC, Corp. Hospital beds and accessories. Medicare Local Coverage Determination (LCD) No. L5049. Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Jurisdiction A. Hingham, MA: NHIC; revised January 1, 2008.
Cullum N, Petherick E. Pressure ulcers. In: BMJ Clinical Evidence. London, UK: BMJ Publishing Group; updated February 2007.
National Heritage Insurance Company (NHIC). Repair labor billing and payment policy. Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Jurisdiction A. Chico, CA: NHIC; February 26, 2009.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.