Hospital Bed

Semi-Electric Hospital Bed

A hospital bed is slightly longer and narrower than a twin-size bed. The head and knee sections of a semi-electric bed are adjusted by means of a power operated hand control. The Semi-Electric Hospital Bed is needed by a patient who requires immediate and/or frequent changes in body positioning because of pain, difficulty breathing, or traction. This type of bed is helpful when the patient is left alone so that he can make his own position adjustments. Semi-Electric Hospital Bed height adjustment is manual.

HCPCS Code:

E0260 (bed w/mattress/rails)
E0261 (bed w/o mattress/w/rails) – use E0261 when
providing a pressure reducing replacement mattress
E0910 (trapeze / bed accessory)

Category:

Capped Rental

Common Diagnosis:

(check for current coding)

428.0 Congestive Heart Failure
342.9 Hemiplegia Right/Left
496 COPD
344.0 Quadriplegia
355.2 Amyotrophic Lateral Sclerosis

Coverage Information

Requires a detailed written order

Covered if indications one or more of 1 through 4 are met, and indication 5 is met:

1. A patient who requires positioning of the body in ways not feasible with an ordinary bed due to a medical condition which is expected to last at least one month.

2. A patient who requires, for the alleviation of pain, positioning of the body in ways not feasible with an ordinary bed.

3. A patient who 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.

4. A patient who requires traction equipment which can only be attached to a hospital bed.

5. The patient requires frequent changes in body position and/or has an immediate need for a change in body position (this qualifies semi-elect. versus manual bed).

E0265: A full electric bed (E0265) adds height adjustment to the bed. This is a convienence feature for the caregiver and is therefore not covered by Medicare. Claims for an E0265 full electric bed will be denied as not medically necessary.

You may use an ABN to offer the patient a paid upgrade if they request a full electric bed, or a free upgrade using the code for the covered item (E0260) and a GL modifier on the claim to denote free upgrade. (See ABN training).

Note 1: Use KX modifier to denote that patient meets coverage criteria and that required
documentation is on file with the supplier.

Note 2: HCPCS codes for mattresses (E0271) and rails (E0310) are not valid on initial set-up and may only be used to bill replacement parts once the rental period of the bed has capped out. You may NOT unbundle the codes in order to maximize reimbursement.

Note 3: When providing a support surface, such as a Group II mattress required for decubitus care, you must bill using code E0261 (semi-electric bed with rails, but without mattress).

Otherwise you will receive a same or similar denial on the Group II support surface mattress since you would essentially be billing for two mattresses when you bill E0260 and a code for a Group II support surface. In this situation, you would also need the documentation required for the support surface (see Group II support surface cheat sheet.)

Documentation Requirements: in addition to the basic Medicare documentation (proof of delivery, AOB, detailed written order, etc.)

• Medicare requires that the ordering physician’s chart notes or other physician documentation support the coverage criteria listed above. Oftentimes the most recent history and physical (a common document in most medical records) will include information that supports the need described in the coverage criteria. You may choose to ask for this at the time you request the detailed written order, or you can obtain only if requested during a routine or random audit by Medicare.

• The detailed written order form must contain the patient’s name, and a description of the item provided, length of need for a recurring rental item, physician signature and date, and the start date of the order if different than the physician signature date.