Hospital Beds & Accessories

Affected Providers

Physicians and non-physician practitioners who write prescriptions or orders for hospital beds and accessories.

HCPCS & CPT Codes

Local Coverage Determination (LCD): Hospital Beds And Accessories (L33820) has the current HCPCS and CPT codes.

Background

According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the improper payment rate for hospital beds and accessories is 27.3%, with a projected improper payment amount of $16 million.

You must meet the provisions in National Coverage Determination (NCD): Hospital Beds (280.7). We outline other policy requirements in 

• LCD L33820
• Article: Hospital Beds and Accessories (A52508)
• Article: Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426).

Denial Reasons

Insufficient documentation accounted for 82.6% of improper payments for hospital beds and accessories during the 2024 reporting period, while other errors (17.4%) also caused improper payments.

Preventing Denials

General Coverage Requirements

We require a practitioner add documentation that the Medicare Administrative Contractor (MAC) medical staff may consider necessary, including medical records and practitioners’ reports that must prove the hospital bed’s medical necessity because the patient’s condition requires 1 of these:

• Body positioning (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
• Special attachments not fixable to or used on an ordinary bed

Variable Height Feature

According to NCD 280.7, in well-documented cases, the MAC may find that a hospital bed’s variable height feature is medically necessary. That feature is covered for 1 of these conditions:

• 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 in quadriplegic and paraplegic patients, multiple limb amputees, and stroke patients who can transfer from a bed to a wheelchair, with or without help.
• Other severely debilitating diseases and conditions in which the patient requires the variable height feature to ambulate.

According to LCD L33820, we cover a variable-height hospital bed (HCPCS codes E0255, E0256, E0292, and E0293) if the patient meets 1 of the criteria for a fixed-height hospital bed and requires a bed height different from that of a fixed-height hospital bed to transfer to a chair, wheelchair, or standing position.

We cover a fixed-height hospital bed (HCPCS codes E0250, E0251, E0290, E0291, and E0328) if the patient meets 1 or more of these criteria:

• Has a medical condition that requires body positioning in ways that can’t be done with an ordinary bed. Elevation of the head and upper body less than 30 degrees doesn’t usually require using a hospital bed.
• Requires body positioning to alleviate pain in ways that can’t be done with an ordinary bed.
• 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.
• Requires traction equipment that can be attached only to a hospital bed.

Semi-Electric Powered Hospital Bed Adjustments

We may cover electric powered adjustments to lower and raise the patient’s head and foot when MAC medical staff decide that:

• 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 make the adjustments. We may make exceptions to this last requirement in cases of spinal cord injury and brain-injured patients.

We cover a semi-electric hospital bed (HCPCS codes E0260, E0261, E0294, E0295, and E0329) if the patient meets 1 of the criteria for a fixed-height bed and requires frequent changes in body position or has an immediate need for a change in body position.

We don’t cover a total electric hospital bed (HCPCS codes E0265, E0266, E0296, and E0297); the height adjustment feature is a convenience feature, so we deny them as not reasonable and necessary.

We cover a heavy-duty extra-wide hospital bed (HCPCS codes E0301 and E0303) if the patient meets 1 of the criteria for a fixed-height hospital bed and their weight is more than 350 pounds but doesn’t exceed 600 pounds.

We cover an extra heavy-duty hospital bed (HCPCS codes E0302 and E0304) if the patient meets 1 of the criteria for a hospital bed and their weight is more than 600 pounds.

For any of these hospital beds (plus those billed with HCPCS code E1399 — see the Coding Guidelines section of Article A52508), if the documentation doesn’t justify the medical need of the type of bed you billed, we deny payment as not reasonable and necessary.

Accessories

We cover:

• Trapeze equipment (HCPCS codes E0910 and E0940) if the patient 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 (HCPCS codes E0911 and E0912) if the patient meets the criteria for regular trapeze equipment and their weight is more than 250 pounds
• A bed cradle (HCPCS code E0280) when it’s necessary to prevent contact with the bed coverings
• Side rails (HCPCS codes E0305 and E0310) or safety enclosures (HCPCS code E0316) when they’re required by the patient’s condition and they’re an integral part of, or an accessory to, a covered hospital bed
• A replacement innerspring mattress (HCPCS code E0271) or foam rubber mattress (HCPCS code E0272) for a patient-owned hospital bed, if a patient’s condition requires it

Documentation Requirements

To justify payment, you must meet specific requirements when ordering DMEPOS.

Example of Improper Payments Due to Insufficient Documentation for Hospital Beds

A supplier bills the claim for HCPCS code E0292 (Hospital bed, variable height, hi-lo, without side rails, with mattress) and submits the following documentation per the review contractor’s request:

• Standard written order with correct HCPCS coding
• Treating practitioner’s medical record that doesn’t meet the criteria for reasonable and necessary
• Proof of delivery

What Documentation Was Missing?

Although the patient’s medical record provided documentation that they met the basic coverage criteria for a fixed-height hospital bed, it didn’t have a complete description stating the patient requires a bed height different from that of a fixed-height hospital bed to permit transfers to a chair, wheelchair, or standing position.

What Happens Next?

The review contractor completes the claim as an insufficient documentation error, and the MAC recoups payment.

Recommendation

To justify payment, the certifying physician must document in the patient’s medical record that the patient meets coverage criteria for a fixed-height hospital bed (HCPCS codes E0250, E0251, E0290, E0291, and E0328) and that the patient requires a variable-height hospital bed (HCPCS codes E0255, E0256, E0292, and E0293) to permit transfers to a chair, wheelchair, or standing position.