Hospital beds are used for positioning patients. Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare in order to assist recipients for whom MHCP is not the primary payer. MHCP quantity limits and thresholds apply to all recipients unless only Medicare co-insurance or deductible is requested. Hospital beds are covered for eligible MHCP recipients who meet the medical necessity criteria. Codes: E0250, E0251, E0290, E0291 Covered for recipients with one of the following medical conditions: Codes: E0255, E0256, E0292, E0293 Covered for recipients who meet criteria for a fixed height manual hospital bed and require one of the following criteria: Codes: E0260, E0261, E0294, E0295 Codes: E0265, E0266, E0296, E0297 Covered for recipients who meet criteria for a hospital bed and both of the following criteria: Covered for recipients who meet criteria for the type of hospital bed requested (manual, semi-electric, total electric) and whose weight is within the capacity limits of the requested bed.
Covered for recipients who meet criteria for a manual, semi-electric or total electric hospital bed and who have medical needs best met by a pediatric sized bed. The bed must be reasonably expected to meet the recipient’s needs for at least 5 years. Codes E0316 (enclosure), E0300 (hospital grade enclosed crib), E1399 (Enclosed bed manufactured as a unit) This type of bed is considered medically necessary and the least costly alternative only in the most extreme conditions due to the restrictive nature of the bed and the confinement it entails. Based on advice from medical consultants, Minnesota Health Care Programs considers an enclosed bed medically necessary when the recipient is cognitively impaired and mobile if his/her unrestricted mobility has resulted in documented injuries sustained as a result of wandering unsupervised. Even then, it must be shown that other, less costly methods have been attempted and have failed to effectively treat the problem. Generally, such confinement is not medically necessary nor the least costly way of managing seizures or behaviors such as head banging, rocking, etc.
Issues of sensory deprivation and the potential for overuse must also be addressed in this process. Coverage will be considered for recipients who have documented evidence of unsafe mobility (climbing out of bed and moving round the home, not just standing at the side of the bed), including mobility that will put the recipient at significant risk for serious injury, not just a possibility of injury. The recipient must meet the following criteria: MHCP believes that there is no clear-cut medical justification for the enclosed bed systems. The real need is to proactively address with intervention the underlying medical and/or behavioral issues that give rise to the risk of harm. Codes: E0271-E0272 (mattress), E0305. Covered when used with a recipient-owned hospital bed. When replacing a mattress on a patient-owned heavy duty or bariatric bed, include “bariatric mattress for patient owned bariatric bed” and the PA number or purchase date for the bed if known in the Claim Notes field on the Claim Information tab or in the line item Notes field on the Services tab in MN–ITS.
For X12 batch submitter refer to the Minnesota Uniform Companion Guides. Use modifiers NU and U3. Submit authorization request and required documentation to the Authorization Medical Review Agent. Not required for rental or purchase Documentation in the provider’s files must establish medical necessity as described above Required after 3 months rental and for all purchases Authorization requests must document the medical condition that requires a hospital bed, and the frequency of severity of symptoms that require repositioning. Include a description of the recipient’s and/or caregiver’s judgment and ability to operate the bed. Total electric hospital beds Always required for purchase or rental Authorization requests must document the medical condition that requires a hospital bed, and the reason that changes in bed height are required. Include documentation that demonstrates that the caregiver is unable to change the bed height manually, but is able to assist with needed cares and transfers.
Bariatric / heavy duty hospital beds Authorization requests must document the medical condition that requires a hospital bed, and the weight of the recipient that justifies a heavy duty hospital bed. Authorization requests must document the medical condition that requires a manual, semi-electric or total electric hospital bed, as well as the medical condition that prevents the use of a standard size hospital bed. Include documentation of the recipient’s current age, height and weight and expected growth. Complete both the Information Needed for Authorization Requests for Enclosed Medical Beds (DHS-4370) (PDF) and the Minnesota Health Care Programs Authorization Form (DHS-4695) (PDF). Submit completed forms to Authorization Medical Review Agent as instructed on authorization forms. Documentation must include a diagnosis that is directly linked to the need for the enclosed bed, a complete description of the recipient’s mobility, documentation of the specific risk from unrestricted bedtime mobility, the recipient’s history of injuries (or near-injuries) related to bedtime mobility, all less costly and less intrusive alternatives tried or considered and why they were rejected, and all other information requested on the authorization form.
• Codes E0250, E0255, E0260, E0265, E0303, E0304, E0328, and E0329 include the bed, bed rails and mattress. Do not bill rails (E0305, E0310) or mattress (E0271, E0272) within 180 days of billing these codes. • Codes E0251, E0256, E0261, E0266, E0301, and E0302 include the bed and bed rails. Do not bill rails (E0305, E0310) within 180 days of bill these codes. • Codes E0290, E0292, E0294 and E0296 include the bed and mattress. Do not bill mattress (E0271, E0272) within 180 days of billing these codes. • Use X12 Batch or MN–ITS 837P Professional electronic claim • Report the ordering provider in the Other Provider Types section of the MN–ITS Interactive claim • If the recipient has Medicare, MHCP will pay only the deductible / co-insurance on any item for which Medicare made payment, regardless of any MHCP prior authorization. • If the recipient has Medicare, any items for which Medicare denies payment must meet MHCP coverage and authorization requirements.