Article Detail - JA DME

General coverage requirements must exist in the medical records and practitioners’ reports that prove the hospital bed’s medical necessity due to one of these reasons:

• The patient’s condition requires positioning of the body (for example, to alleviate pain, promote good body alignment, prevent contractures, and avoid respiratory infections) in ways that aren’t workable in an ordinary bed
• The patient’s condition requires special attachments not fixable or used on an ordinary bed

Variable height features are considered medically necessary when the beneficiary meets one of the Local Coverage Determination (LCD) defined criteria for a fixed height hospital bed and requires a bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair or standing position. While the policy requirements are not diagnosis dependent, medical documentation may include the following conditions to support variable height criteria:

• Severe arthritis and other injuries to lower extremities (for example, fractured hip). The condition requires the variable height feature to help the patient place their feet on the floor while sitting on the edge of the bed
• Severe cardiac conditions. For those cardiac patients who can leave bed, but who must avoid the strain of "jumping" up or down
• Spinal cord injuries, including quadriplegic and paraplegic patients, multiple limb amputees, and stroke patients. For those patients who can transfer from a bed to a wheelchair, with or without help
• Other severely debilitating diseases and conditions if the patient requires the variable height feature to ambulate

Semi-electric powered hospital beds may be covered to lower and raise the patient’s head and foot when the beneficiary meets the LCD defined criteria for a fixed height hospital bed and:

• The patient’s condition requires frequent change in body position
• The patient may need an immediate change in body position (no delay is tolerable), and they can work the controls and cause the adjustments (exceptions to this last requirement in cases of spinal cord injury and brain-injured patients)

Hospital beds with additional or different features from those described above must meet the criteria defined in the LCD. Total electric hospital beds with electric height adjustment and with electric head and leg elevation adjustments are not covered. Accessories may be covered for the hospital bed when the medical necessity exists in the beneficiary’s medical record.

Reference: MLN4824456 - Medicare Provider Compliance Tips (cms.gov)