American Home Health Care provides three types of beds:
Indications and Limitations of Coverage and/or Medical Necessity:
A fixed height hospital bed (E0250, E0251, E0290, and E0291) is covered if one of more of the following criteria are met:
1) The patient 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
2) The patient requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain, or
3) The patient requires the head of the bed to be eleveated 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 and ruled out, or
4) The patient requires traction equipment, which can only be attached to a hospital bed.
A semi-electric hospital bed (E0260, E0261, E0294, and E0295) is covered if the patient 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 patient meets one of the criteria for a fixed height hospital bed and the patient'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 patient meets one of the criteria for a hospital bed and the patient'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.
If the patient does not meet any of the coverage criteria for any type of hospital bed it will be denied as not medically necessary.
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An order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available to the DMERC upon request.
A Certificate of Medical Necessity (CMN) which has been completed, signed, and dated by the treating physician must be kept on file by the supplier and made available to the DMERC on request.
A claim for code E1399 must be accompanied by:
- A Hospital Bed CMN, HCFA Form 841 that must include the patient's weight, and,
- The manufacturer and model/product name/number of bed; and,
- Information which describes the necessity for the bed.
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