Medicare Hospital Bed LCD Coverage
A fixed height hospital bed (E0250,E0251,E0290,E0291,E0328)is covered if one or more of the following criteria are met:
- The beneficiary has a medical condition which requires positioning of the body in ways not feasible with an ordinary bed. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed, or
- The beneficiary requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain, or
- The beneficiary 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, or
- The beneficiary requires traction equipment, which can only be attached to a hospital bed.
A variable height hospital bed (E0255, E0256, E0292, and E0293) is covered if the beneficiary meets one of the 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.
A semi-electric hospital bed (E0260, E0261, E0294, E0295, and E0329) is covered if the beneficiary 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 heavy duty extra wide hospital bed (E0301, E0303) is covered if the beneficiary meets one of the criteria for a fixed height hospital bed and the beneficiary’s weight is more than 350 pounds, but does not exceed 600 pounds.
An extra heavy-duty hospital bed (E0302, E0304) is covered if the beneficiary meets one of the criteria for a hospital bed and the beneficiary’s weight exceeds 600 pounds.
A total electric hospital bed (E0265, E0266, E0296, and E0297) is not covered; the height adjustment feature is a convenience feature. Total electric beds will be denied as not reasonable and necessary.
If the beneficiary does not meet any of the coverage criteria for any type of hospital bed it will be denied as not reasonable and necessary.
ACCESSORIES:
Trapeze equipment (E0910, E0940) is covered if the beneficiary needs this device to sit up because of a respiratory condition, to change body position for other medical reasons, or to get in or out of bed.
Heavy duty trapeze equipment (E0911, E0912) is covered if the beneficiary meets the criteria for regular trapeze equipment and the beneficiary’s weight is more than 250 pounds.
A bed cradle (E0280) is covered when it is necessary to prevent contact with the bed coverings.
Side rails (E0305, E0310) or safety enclosures (E0316) are covered when they are required by the beneficiary’s condition and they are an integral part of, or an accessory to, a covered hospital bed.
If a beneficiary’s condition requires a replacement innerspring mattress (E0271) or foam rubber mattress (E0272) it will be covered for a beneficiary owned hospital bed.
HCPCS CODES:
FIXED HEIGHT BEDS: Group 1 Codes
|
Code |
Description |
|
E0250 |
HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITH MATTRESS |
|
E0251 |
HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS |
|
E0290 |
HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITH MATTRESS |
|
E0291 |
HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITHOUT MATTRESS |
|
E0328 |
HOSPITAL BED, PEDIATRIC, MANUAL, 360 DEGREE SIDE ENCLOSURES, TOP OF HEADBOARD, FOOTBOARD AND SIDE RAILS UP TO 24 INCHES ABOVE THE SPRING, INCLUDES MATTRESS |
Group 2 (4 Codes)
Group 2 Paragraph VARIABLE HEIGHT BEDS
Group 2 Codes
|
Code |
Description |
|
E0255 |
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITH MATTRESS |
|
E0256 |
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS |
|
E0292 |
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITH MATTRESS |
|
E0293 |
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITHOUT MATTRESS |
Group 3 (5 Codes)
Group 3 Paragraph SEMI-ELECTRIC BEDS
Group 3 Codes
|
Code |
Description |
|
E0260 |
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE RAILS, WITH MATTRESS |
|
E0261 |
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS |
|
E0294 |
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS, WITH MATTRESS |
|
E0295 |
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS, WITHOUT MATTRESS |
|
E0329 |
HOSPITAL BED, PEDIATRIC, ELECTRIC OR SEMI-ELECTRIC, 360 DEGREE SIDE ENCLOSURES, TOP OF HEADBOARD, FOOTBOARD AND SIDE RAILS UP TO 24 INCHES ABOVE THE SPRING, INCLUDES MATTRESS |
Group 4 (4 Codes)
Group 4 Paragraph TOTAL ELECTRIC BEDS
Group 4 Codes
|
Code |
Description |
|
E0265 |
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE SIDE RAILS, WITH MATTRESS |
|
E0266 |
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS |
|
E0296 |
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITHOUT SIDE RAILS, WITH MATTRESS |
|
E0297 |
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITHOUT SIDE RAILS, WITHOUT MATTRESS |
Group 5 (4 Codes)
Group 5 Paragraph HEAVY DUTY BEDS
Group 5 Codes
|
Code |
Description |
|
E0301 |
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 |
|
E0302 |
HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 600 POUNDS, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS |
|
E0303 |
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 |
|
E0304 |
HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 600 POUNDS, WITH ANY TYPE SIDE RAILS, WITH MATTRESS |
Group 6 (13 Codes)
Group 6 Paragraph ACCESSORIES
Group 6 Codes
|
Code |
Description |
|
E0271 |
MATTRESS, INNERSPRING |
|
E0272 |
MATTRESS, FOAM RUBBER |
|
E0273 |
BED BOARD |
|
E0274 |
OVER-BED TABLE |
|
E0280 |
BED CRADLE, ANY TYPE |
|
E0305 |
BED SIDE RAILS, HALF LENGTH |
|
E0310 |
BED SIDE RAILS, FULL LENGTH |
|
E0315 |
BED ACCESSORY: BOARD, TABLE, OR SUPPORT DEVICE, ANY TYPE |
|
E0316 |
SAFETY ENCLOSURE FRAME/CANOPY FOR USE WITH HOSPITAL BED, ANY TYPE |
|
E0910 |
TRAPEZE BARS, A/K/A PATIENT HELPER, ATTACHED TO BED, WITH GRAB BAR |
|
E0911 |
TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS, ATTACHED TO BED, WITH GRAB BAR |
|
E0912 |
TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS, FREE STANDING, COMPLETE WITH GRAB BAR |
|
E0940 |
TRAPEZE BAR, FREE STANDING, COMPLETE WITH GRAB BAR |
Group 7 (1 Code)
Group 7 Paragraph MISCELLANEOUS
Group 7 Codes
|
Code |
Description |
|
E1399 |
DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS |
The CMS.gov website is an excellent resource for finding out about all of your options.
