Safety Items

Number: 0623

Policy

Notes:

Most standard Aetna benefit plans specifically exclude coverage of safety items.  Examples of safety items include adaptive full-length side safety rail (SleepSafe) beds, manual or electric safety bed systems (e.g., KayserBetten Secure Sleep Systems), bed exit monitors (bed alarms), bed rails, belts, car seats (e.g., Carrie Car Seat, Columbia Orthopedic Positioning Seat, Gorilla Postural Seat, Snug Seat, Traveller Plus, Special Tomato MPS Car Seat), fall detection systems, fire extinguishers, first aid kits, grab bars, harnesses, hearing protectors (ear plugs; e.g., DB blockers), helmetsFootnote 1* (e.g., Danmar soft shell helmet), knee and elbow pads, restraints, safety goggles, service dogs, smoke and carbon monoxide detectors, telephone alert systems, and vehicular restraint systems (e.g., EZ-On Vest)).

Aetna standard HMO-based plans typically exclude "coverage furnished to provide a safe surrounding, including the charges for providing a surrounding free from exposure that can worsen the disease or injury."  Standard Aetna non-HMO plans typically exclude charges "for care furnished mainly to provide a surrounding free from exposure that can worsen the person's disease or injury."  Under these plans, safety interventions and devices are excluded from coverage regardless of whether they are an integral and medically necessary component of the management of the member's condition.

For non-standard plans that do not exclude coverage of safety items, Aetna covers safety items for members with diseases or medical conditions that:
  1. place them at increased risk of injury; and/or
  2. make them especially susceptible to harm from injury. 
However, many safety devices may be excluded from coverage because they do not meet Aetna's definition of covered durable medical equipment (DME). See benefit plan descriptions.  Safety items that are normally of use in the absence of illness or injury do not meet Aetna's definition of covered DME. This would include car safety seats, fire extinguishers, first aid kits, knee and elbow pads, safety goggles, and smoke and carbon monoxide detectors. 

Under non-standard plans that do not exclude safety items, continuously worn prefabricated or custom-made soft or hard specialized medical protective helmets are considered medically necessary to prevent injury due to frequent, violent or uncontrolled seizures, balance disorders, head banging behaviors, or following cranial surgery. Annual replacement of the replacement liner is considered medically necessary and covered for persons who qualify for coverage of a specialized helmet.

Telephone alert systems are not covered because they are not considered by Aetna to fall within the contractual definition of DME in that they are normally of use in the absence of illness or injury. (Telephone alert systems relay pre-programmed messages to pre-determined telephone contacts when an individual activates a distress signal.  The distress signal activator is worn as a necklace or bracelet). In addition, telephone alert systems are considered safety items, which are contractually excluded under most benefit plans. Telephone alert systems are also known as emergency medical alert button systems (e.g., AlertOne, Lifeline, etc.), Please check benefit plan descriptions for details.

Under nonstandard plans that do not exclude safety items, grab bars that are affixed to a wall or floor, such as around the bathtub or toilet, are not covered under the standard exclusion for addition or alternations to a home, workplace or other environment. Please see benefit plan descriptions.

Under nonstandard plans that do not exclude safety items, hospital bedside rails, hospital bed safety enclosure framesFootnote 2**, and enclosed hospital-grade pediatric cribs would be considered medically necessary for persons with neurocognitive or physical disabilities that place them at increased risk for falling from the bed. Under these plans, safety equipment (e.g., belt, harness or vest) would be considered medically necessary for persons with neurocognitive or physical disabilities that place them at increased risk for falls. Restraints (body, chest, wrist or ankle) and vehicular restraint systems would be considered medically necessary for persons with neurocognitive or physical disabilities that place them increased risk of injury.

Under nonstandard plans that do not exclude safety items, safety and athletic prescription lenses and frames would be excluded from coverage under the standard vision exclusion. Please check benefit plan descriptions.

Footnote 1* A specialized helmet may be covered as a prosthetic of the skull when medically necessary after cranial surgery. For cranial remodeling helmets/bands for plagiocephaly, see CPB 0379 - Cranial Remodeling.

Footnote 2** For coverage of hospital bed safety enclosure frames that are part of a medically necessary hospital bed, see CPB 0543 - Hospital Beds and Accessories.

Table: CPT Codes / HCPCS Codes / ICD-10 Codes
Code Code Description

Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":

Other CPT codes related to the CPB:
61304 - 61619 Craniectomy or craniotomy and other cranial surgeries

HCPCS codes not covered for indications listed in the CPB:
Hearing protectors (ear plugs; e.g., DB blockers) - no specific code
A8000 Helmet, protective, soft, prefabricated, includes all components and accessories [covered as a prosthetic of the skull when medically necessary after cranial surgery]
A8001 Helmet, protective, hard, prefabricated, includes all components and accessories [covered as a prosthetic of the skull when medically necessary after cranial surgery]
A8002 Helmet, protective, soft, custom fabricated, includes all components and accessories
A8003 Helmet, protective, hard, custom fabricated, includes all components and accessories [covered as a prosthetic of the skull when medically necessary after cranial surgery]
A8004 Soft interace for helmet, replacement only [covered as a prosthetic of the skull when medically necessary after cranial surgery]
E0241 Bathtub wall rail, each
E0242 Bathtub rail, floor base
E0243 Toilet rail, each
E0300 Pediatric crib, hospital grade, fully enclosed, with or without top enclosure
E0305 Bedside rails, half-length
E0310 Bedside rails, full-length
E0316 Safety enclosure frame / canopy for use with hospital bed, any type
E0700 Safety equipment (e.g., belt, harness or vest)
E0710 Restraint, any type (body, chest, wrist or ankle)
S0504 Single vision prescription lens (safety, athletic, or sunglass), per lens
S0506 Bifocal vision prescription lens (safety, athletic, or sunglass), per lens
S0508 Trifocal vision prescription lens (safety, athletic, or sunglass), per lens
S0510 Non-prescription lens (safety, athletic, or sunglass), per lens
S0516 Safety eyeglass frames
S5160 Emergency response system; installation and testing
S5161 Emergency response system; service fee, per month (excludes installation and testing)
S5162 Emergency response system; purchase only
T1005 Positioning seat for persons with special orthopedic needs
T1014 Telehealth transmission, per minute, professional services bill separately

The above policy is based on the following references:

  1. American Academy of Pediatrics. Selecting and using the most appropriate car safety seats for growing children: Guidelines for counseling parents. Pediatrics. 2002;109(3):550-553.
  2. Anderson O, Boshier PR, Hanna GB. Interventions designed to prevent healthcare bed-related injuries in patients. Cochrane Database Syst Rev. 2012;(1):CD008931.  
  3. Everitt V, Bridel-Nixon J. The use of bed rails: Principles of patient assessment. Nurs Stand. 1997;12(6):44-47.
  4. SleepSafe Beds, LLC. The SleepSafe [website]. Callaway, VA; SleepSafe Beds; 2008. Available at: http://www.sleepsafebed.com/. Accessed August 5, 2008.
  5. Thompson DC, Rivara FP, Thompson R. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database Syst Rev. 1999;(4):CD001855.
  6. U.S. Department of Health and Human Services, Public Health Service, Office of Disease Prevention and Health Promotion. Clinician's Handbook of Preventive Services. 2nd ed. Washington, DC: U.S. Government Printing Office; 1998.
  7. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services: Report of the U.S. Preventive Services Task Force. 2nd ed. Baltimore, MD: Williams & Wilkins; 1996.
  8. Werner P, Koroknay V, Cohen-Mansfield J. To use physical restraints or not. J Am Geriatr Soc. 1997;45(2):253.
  9. Werner P. Perceptions regarding the use of physical restraints with elderly persons: Comparison of Israeli health care nurses and social workers. J Interprof Care. 2002;16(1):59-68.