Please note that this criteria is taken and summarized directly from Noridian Medicare's LCD page. We try to keep this updated as possible. For the full article, please click here.
Hospital Bed Criteria**Patient must at least qualify for a Fixed Height Hospital Bed before qualifying for other types of beds
Also note that we will only provide a semi-electric hospital bed or a bariatric/heavy duty semi-electric hospital bed through insurance.
Fixed Height Hospital Beds• 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 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. Pillows or wedges must have been considered and rules out; or
• The beneficiary requires traction equipment, which can only be attached to a hospital bed.
Semi-Electric Hospital Bed• The beneficiary meets coverage criteria for a fixed height hospital bed; and
• The beneficiary requires frequent changes in body positions; and / or
• The beneficiary has an immediate need for a change in body position.
Bariatric Semi-Electric Hospital Bed• The beneficiary meets coverage criteria for a fixed height hospital bed and a semi-electric hospital bed; and
• The beneficiary weighs over 300 pounds, but less than 600 pounds (height and weight must be on prescription); or
• The beneficiary weighs over 600 pounds (height and weight must be on prescription)
Hospital Bed Accessories
Trapeze EquipmentThe benefciary needs the 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 EquipmentThe benefciary meets the criteria for regular trapeze equipment (see above) and the patient’s weight is more than 250 pounds.
Questions to ask your patientsMust be noted somewhere in your clinical documentations.
This is not an all-inclusive list of questions.
• How is the hospital bed going to help their condition?
• What is the severity of their condition? We need more than just a diagnosis.
• What is the frequency of symptoms?
• Why do they need special positioning?
• How is the bed going to alleviate the pain?