Medical policy: Hospital Beds and Accessories

Número de política: MP 6.001

Fecha de entrada en vigor: 3/1/2026

Política

Fixed-height hospital bed may be considered medically necessary when one or more of the following criteria are met:

• The individual has a medical condition which requires positioning of the body and support to alleviate pain, provide good body alignment, prevent contractures, or avoid respiratory infections that is not feasible in an ordinary bed.
• The individual 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 aspirations.
• The individual requires traction equipment, which cannot be attached to an ordinary bed.

Variable-height hospital bed may be considered medically necessary when an individual meets one or more criterion for a fixed-height hospital bed and at least one of the following criteria:

• The individual has severe arthritis or other injuries to the lower extremities (e.g., fractured hip), or other severely debilitating disease or conditions, and the variable height feature assists the individual to ambulate or transfer by enabling the individual to place feet flat on the floor when sitting on the edge of the bed.
• An individual with any condition that would be aggravated by the strain of “jumping” up or down.
• The individual is able to transfer from bed to wheelchair, with or without help. This would include conditions including, though not limited to, spinal cord injuries, multiple limb amputations, or severe stroke (CVA); or
• An adult caregiver is able and willing to provide daily assistance with activities of daily living (ADLs) while the individual is in bed (e.g., repositioning, dietary needs, fluid balance, skin care, continence management of altered mental status).
  • Caregiver training may be medically necessary to ensure safe body mechanics in the care and transfer of the individual (i.e., adjustment of bed height for tasks, use of bed rails, etc.), measures to prevent pressure injuries, use of safe repositioning techniques and supportive devices, appropriate daily skin care, and provision of nutrition to support skin integrity and wound healing.

Semi-electric hospital bed may be considered medically necessary when the individual meets one or more of a fixed-height hospital bed criteria above and both of the following:

• Requires frequent changes in body position and/or has an immediate need for a change in body position (i.e., no delay can be tolerated); and
• Able to operate the controls to make the adjustments. Exceptions to this requirement can be made in cases of spinal cord injury or brain injury.

Total electric bed is considered a convenience feature and therefore investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Heavy-duty extra wide hospital bed may be considered medically necessary if the individual meets one of the criteria for a fixed-height hospital bed and the individual’s weight is more than 350 pounds but does not exceed 600 pounds.

Extra heavy-duty hospital bed may be considered medically necessary if the individual meets the criteria for a fixed-height hospital bed and the individual’s weight exceeds 600 pounds.

Kinetic (oscillating) beds and hospital grade beds (including pediatric hospital grade beds) are considered institutional equipment and inappropriate for home use and therefore investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Power or manual lounge beds (i.e., Adjust-A-Bed, Craftmatic Bed, or Electra-Rest bed) are considered convenience items, as they are not hospital beds or primarily medical in nature and therefore investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Pediatric hospital crib/bed, including a pediatric hospital bed with 360° side enclosures, may be considered medically necessary when the individual meets all of the medical necessity criteria for one of the hospital beds specified above.

Hospital beds of any type will be considered investigational if the individual does not meet the above criteria. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

*Note: To prevent pressure injury in an individual the caregiver must provide frequent changes in positioning at least every two hours, use of supportive devices, daily skin care, and nutritious diet.

Hospital bed accessories

• Bed boards are considered a convenience item and therefore investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.
• Bed cradle may be considered medically necessary to prevent contact with bed coverings.
• Canopy enclosures may be medically necessary when the following are met:
  • Criteria for a hospital bed listed above is met.
  • A medical condition that requires a safety enclosure.
  • Less restrictive options are unsuccessful.
• Trapeze equipment may be considered medically necessary if the individual requires device to do any of the following:
  • Sit up due to respiratory conditions.
  • Change body position for other medical reasons.
  • To get in or out of bed.
• Heavy-duty trapeze equipment may be considered medically necessary if the individual meets both of the following:
  • The individual meets the criteria above for regular trapeze.
  • The individual’s weight is greater than 250 pounds.
• Trapeze bars attached to a bed are investigational when used on an ordinary bed. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.
• Side rails or safety enclosures may be considered medically necessary when required for the individual’s condition and are an integral part of, or an accessory to, a hospital bed.
• Support surfaces: alternating pressure pads and mattresses, water and pressure pads and mattresses, gel flotation pads or mattresses and lamb’s wool pads, etc. may be considered medically necessary if the individual has or is highly susceptible to decubitus injury and the individual’s physician has specified that they will be supervising its use in connection with the course of treatment.
• Over bed table is considered a convenience item and therefore investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

The following beds or accessories are considered safety/convenience items and investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

• Safety bed systems (e.g., KayserBetten Secure Sleep Systems, SleepSafe Bed, Hannah Safety Bed, Dream Series, Safety Sleeper™)
• Safety accessories such as enclosures/canopies for a bed other than a hospital bed (e.g., Vail^® Enclosed Bed Systems, Posey Bed Canopy beds)
• Bed rocker and rocking beds

Cross-references:

• MP 1.094 Skin contact monochromatic infrared energy for the treatment of cutaneous ulcers, diabetic neuropathy, and other miscellaneous musculoskeletal conditions
• MP 6.026 Durable medical equipment (DME) and supplies
• MP 8.001 Physical medicine and specialized physical medicine treatments (outpatient)

Variaciones del producto

Esta política solo se aplica a ciertos programas y productos administrados por Capital Blue Cross y está sujeta a variaciones en los beneficios. Consulte la información adicional a continuación.

FEP PPO - Consulte el Manual de Políticas Médicas de FEP.

Descripción/antecedentes

Durable medical equipment (DME), also referred to as home medical equipment (HME), is any equipment which provides therapeutic benefits to a patient with a specific illness, injury, or medical condition. Hospital beds (manual or electric) and other specialized beds, such as active (dynamic) beds, may be considered durable medical equipment.

Active (dynamic) beds include air-fluidized (e.g., Clinitron, FluidAir), low-air-loss beds (e.g., Flexicair, KinAir), or rotating (oscillating) beds. A low-air-loss mattress consists of air sacs through which warmed air passes. An air-fluidized mattress contains silicone-coated beads that liquefy when air is pumped through them. An active bed is one potential component of a comprehensive pressure injury prevention protocol.

A kinetic (oscillating) bed is a programmable bed that turns on its longitudinal axis, intermittently or continuously. Kinetic bed therapy has been proposed for those with acute respiratory conditions, but published literature indicates that it offers no advantage in pressure injury prevention.

In addition to beds, various overlay support surfaces (dynamic and static) are utilized as part of a treatment program for the prevention of pressure injuries. Dynamic overlays include systems with alternating surfaces powered by a pump. Static support surfaces include air, fluid, or gel filled overlays, foam mattresses, and sheepskin.

On March 22, 2005, the U.S. Food and Drug Administration (FDA) and the U.S. Department of Justice initiated seizures of all finished Vail 500, 1000, and 2000 Enclosed Bed Systems on the ground that use of these systems poses a public health risk because patients can become entrapped and suffocate, resulting in severe neurological damage or death.

A number of scales have been proposed for assessing risk for pressure injury development. The Braden scale is used across many settings and subpopulations and has been determined to be valid and reliable. The Braden scale risk levels have been adapted to pediatrics in the form of the Braden Q scale. The lower the Braden scale score, the higher the level of risk for developing pressure injuries.

Definiciones

Basic activities of daily living (BADL) include skills required to manage one’s basic physical needs including personal hygiene or grooming, dressing, toileting, transferring or ambulating, and eating.

Bottoms out/bottoming out is the finding that an outstretched hand can readily palpate the bony prominence (coccyx or lateral trochanter) when it is placed palm up beneath the undersurface of the mattress or overlay and there is an area under the bony prominence.

Fixed height hospital bed is one with manual head and leg elevation adjustments but no height adjustment.

Pressure injury is a type of wound that forms as a result of prolonged pressure against areas of the skin. This is commonly seen over the bony prominences, such as sacrum and heels, in bedridden and/or wheelchair confined individuals.

Semi-electric bed is one with manual height adjustment and with electric head and leg elevation adjustments.

Total electric bed is one with electric height adjustment and with electric head and leg elevation adjustments.

Variable height hospital bed is one with manual height adjustment and with manual head and leg elevation adjustments.

Exención de responsabilidad

Las políticas médicas de Capital Blue Cross se utilizan para determinar la cobertura de tecnologías, procedimientos, equipos y servicios médicos específicos. Estas políticas médicas no constituyen asesoramiento médico y están sujetas a cambios según lo exija la ley o las pruebas clínicas aplicables de las directrices de tratamiento independientes. Los proveedores que brindan tratamiento son individualmente responsables de los consejos médicos y el tratamiento de los miembros. Estas políticas no son una garantía de cobertura o pago. El pago de las reclamaciones está sujeto a la determinación del programa de beneficios del miembro y la elegibilidad en la fecha del servicio, y a la determinación de que los servicios son médicamente necesarios y apropiados. El procesamiento final de una reclamación se basa en los términos del contrato que se aplican al programa de beneficios de los miembros, incluidas las limitaciones y exclusiones de beneficios. Si un proveedor o miembro tiene alguna pregunta sobre esta política médica, debe comunicarse con Servicios para proveedores o Servicios para miembros de Capital Blue Cross.

Información de codificación

Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. La identificación de un código en esta sección no denota cobertura, ya que la cobertura está determinada por los términos de la información de beneficios del miembro. Además, no todos los servicios cubiertos son elegibles para un reembolso por separado.

En fase de investigación:

Kinetic (oscillating) and hospital grade beds (including pediatric hospital grade beds) are considered institutional equipment and inappropriate for home use.

Over-bed table and bed boards are considered convenience items.

Total electric hospital beds (adult and pediatric), which include a height adjustment feature, are considered convenience items.

Pediatric safety beds, manufactured as a unit (e.g., KayserBetten Sleep Systems, SleepSafe Beds, and Dream Series Beds), are considered convenience items.

Power or manual lounge beds (i.e., Craftmatic^®, AdjustaBed, Electra-Rest bed) are considered convenience items.

Bed rocker or rocking bed is considered a safety/convenience item.

Covered when medically necessary:

Pediatric hospital crib/bed with 360° side enclosures.

Hospital beds.

Mattresses, support surfaces, air fluid beds.

Covered when medically necessary: hospital bed accessories

*Specific diagnosis codes do not apply, unless indicated above in the policy statement.

Referencias

1. Berlowitz D. Prevention of pressure ulcer and soft tissue injury. In: UpToDate Online Journal (serial online). Waltham, MA: UpToDate; updated November 2023. Literature review current through August 2025.
2. Centers for Medicare and Medicaid Services (CMS). CMS Internet Only Manual Publication. Pub 100-03. Medicare National Coverage Determinations. Part 4 - Chapter 1: Hospital Beds; §280.1.
3. Centers for Medicare and Medicaid Services (CMS). National Coverage Determination (NCD). 280.7: Hospital beds.
4. Centers for Medicare and Medicaid Services (CMS). National Coverage Determination (NCD). 280.8: Air-fluidized bed.
5. Durable Medical Equipment Regional Carrier (DME MAC JA) Region JA Noridian Healthcare Solutions, LLC Local Coverage Determination (LCD) L33820. Hospital Beds and Accessories. Vigente a partir del 01/01/2020.
6. Goldhill DR, Imhoff M, McLean B, Waldmann C. Rotational bed therapy to prevent and treat respiratory complications: a review and meta-analysis. American Journal of Critical Care. 2007; 16(1): 50-61.
7. Hill-Rom. Clinitron air fluidized therapy bed.
8. Kirman. Pressure injuries (pressure ulcers) and wound care. eMedicine. Updated January 31, 2024.
9. National Pressure Ulcer Advisory Panel (NPUAP). Updated staging system. 2016.
10. Prevention Plus. Braden scale for predicting pressure sore risk.
11. Reger SI, Ranganathan VK, Sahgal V. Support surface interface pressure, microenvironment, and the prevalence of pressure ulcers: an analysis of the literature. Ostomy Wound Management. 2007; 53(10): 50-8.
12. Stechmiller JK, et al. Guidelines for the prevention of pressure ulcers. Wound Repair and Regeneration. 2008; 16(2): 151-58.
13. Taber’s cyclopedic medical dictionary. 20th edition.
14. The National Pressure Ulcer Advisory Panel (NPUAP). Pressure ulcers get new terminology and staging definitions. Nursing. 2017; Mar; 47(3): 68-69.
15. Boyle C, Carpan D, Pandelani T, et al. Lateral pressure equalisation as a principle for designing support surfaces to prevent deep tissue pressure ulcers. PLoS One. 2020; 15(1): e0227064.
16. Minteer D, Simon P, Taylor D, et al. Pressure ulcer monitoring platform-A prospective, human subject clinical study to validate patient repositioning monitoring device to prevent pressure ulcers. Advances in Wound Care. January 2020; 9(1): 28-33.
17. Durable Medical Equipment Regional Carrier (DME MAC JA) Region JA Noridian Healthcare Solutions, LLC Local Coverage Article (LCA) A52490. Pressure reducing support surfaces - Group 2.
18. Durable Medical Equipment Regional Carrier (DME MAC JA) Region JA Noridian Healthcare Solutions, LLC Local Coverage Article (LCA) A52508. Hospital Beds and Accessories.
19. Padula WV, Pronovost PJ, Makic MBF, et al. Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis. BMJ Quality & Safety. 2019; 28(2): 132-141. PMID 30097490
20. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. The International Guideline. 3rd ed. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance. 2019.