Go directly to: Content

NOTICE: You are using a browser without adequate or enabled CSS (style sheet) support. This site will appear plain but remain fully useable. To see this site as it is intended, you need to upgrade to a standards-compliant browser, such as the latest version of Internet Explorer or Netscape.


Hospital Beds and Accessories

Basic Requirements for All Hospital Beds
Following are the general requirements for coverage of all hospital beds:

Pediatric Hospital Beds
The manufacturer's name and model number, or product number, should be submitted with the claim for pediatric hospital beds.

Physician's Certification
The physician's certification must be kept on file along with supplementing documentation, when required, and must establish that a hospital bed meets the following medical criteria for coverage:

Hospital Bed, Fixed Height
A fixed height feature of a hospital bed may be covered if one or more of the following indications are met:

Variable Height Feature  
In well-documented cases, Blue Cross’ Medical Review department may determine that a variable height feature of a hospital bed meets medical criteria for coverage and, therefore, may be covered for one of the following conditions:

Hospital Bed, Variable Height
A variable height feature of a hospital bed may be covered if below indications 1 and/or 2, 3, 4 are met and indication 5 is met:

  1. Patient requires positioning of the body in ways not feasible with an ordinary bed due to a medical condition that is expected to last at least one month. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed.
  2. Patient requires, for the alleviation of pain, positioning of the body in ways not feasible with an ordinary bed.
  3. Patient 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. The use of pillows or wedges must be inadequate or unsuccessful.
  4. Patient requires traction equipment that can only be attached to a hospital bed.
  5. Patient requires a bed height different than a fixed height bed to permit transfers to chair, wheelchair or standing position.

If the documentation does not support the medical criteria for coverage of a variable height bed, but does support the necessity of a fixed height bed, payment is based on the allowance for the least costly alternative.

Hospital Bed, Semi-Electric
A semi-electric feature of a hospital bed may be covered if indications 1 and/or 2, 3, or 4 are met and indication 5 is met:

  1. Patient requires positioning of the body in ways not feasible with an ordinary bed, due to a medical condition that is expected to last at least one month. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed.
  2. Patient requires, for the alleviation of pain, positioning of the body in ways not feasible with an ordinary bed.
  3. Patient 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. The use of pillows or wedges must be inadequate or unsuccessful.
  4. Patient requires traction equipment that can only be attached to a hospital bed.
  5. Patient requires frequent changes in body position and/or has an immediate need for a change in body position.

If the documentation does not support the medical criteria for coverage of a semi-electric bed, but does support the necessity of a lower level bed, the payment is based on the allowance for the least costly alternative.

Hospital Bed, Total Electric
A total electric hospital bed may be covered if indications 1, 2, 3, or 4, and 5 and 6 are met:

  1. Patient requires positioning of the body in ways not feasible with an ordinary bed due to a medical condition that is expected to last at least one month. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed.
  2. Patient requires, for the alleviation of pain, positioning of the body in ways not feasible with an ordinary bed.
  3. Patient 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. The use of pillows or wedges must be inadequate or unsuccessful.
  4. Patient requires traction equipment that can only be attached to a hospital bed.
  5. A significant amount of care must be provided by a caregiver to the patient in bed.
  6. A change of bed height is required at least once daily to enable the caregiver to assist with necessary patient care activities or procedures.

If the documentation supports a lower level bed, payment is based on the allowance for the least costly alternative.

Hospital Bed, Institutional-Type (Includes: Oscillating, Circulating and Stryker Frames, with Mattresses)
Institutional-type hospital beds including oscillating, circulating and Stryker frames with mattresses are non-covered.

Bed Pans
Bed pans are covered if patient is bed-confined.

 Hospital Bed, Heavy-Duty, Extra-Wide, with Any Type Side Rails, with Mattress
Heavy-duty, extra-wide hospital beds with any type sides rails and with a mattress may be covered only if the patient's weight is more than 350 pounds and one or more of the following indications are met:

Bed Cradle
A bed cradle is covered for a patient for whom it is necessary to prevent contact with the bed coverings.

Urinals
Urinals are covered if the patient is bed-confined.

Bed Rails
Bed rails are covered as an integral part of, or an accessory to, a hospital bed if the patient's condition requires bedside rails.

Last Updated July 2010