Electric Hospital Bed Documentation Needs (ACA, Face to Face visit required)
The following qualification criteria need to be documented in the patients’ medical record notes to qualify for the prescribed equipment.  Note: face to face and justification notes are valid for six months.

Electric hospital bed: One of 1-4 AND 5 need to be sufficiently documented to support the need for the prescribed equipment.

1. Explain the patient’s medical condition that requires positioning of the body in ways not feasible with an ordinary bed. Note: Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed. Or

2. Explain why the patient requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain.  Or

3. Explain why 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: Or

4. Explain why the patient requires traction equipment, which can be attached to a hospital bed. AND

5. Explain why the patient requires frequent changes in body position and/or has an immediate need for a change in body position.

Heavy Duty Electric hospital bed – document the above information and the following.

  • Document the patient’s weight.  Note: the patient must weigh 350lbs – 600lbs to qualify.

Extra heavy duty Electric hospital bed – document the above information and the following.

  • Document the patient’s weight.  Note: the patient must weigh more than 600lb to qualify.

Note: A total/full Electric hospital bed is not a covered item; the height adjustment feature is considered a convenience

Diagnosis: See LCD (Local coverage determination) at NGSMedicare.com for any additional qualifying information questions, diagnosis codes and descriptions

Medicare approved detailed equipment descriptions for Electric hospital beds
Hospital bed semi-electric (HCPC-E0260)  Note: Includes any type side rails, and mattress
Hospital bed variable height, hi-lo (HCPC-E0255) Note: Includes any type side rails, and mattress)
Hospital bed heavy duty extra wide, weight capacity 350-600 lbs. (HCPC- E0303) Note: Includes any type side rails, and mattress)
Hospital bed extra heavy duty extra wide weight capacity greater than 600 lbs. (HCPC-E0304) Note: Includes any type side rails, and mattress)

Patient notes/justification – Must be documented using your normal dictation process. Letter of medical necessity, notes wrote on letter head or prescriptions are not valid.

Prescription/order requirements – Must contain Patient’s name, date of the order and Start date, detailed equipment description (See above), Physician’s NPI (national provider number), signature of the ordering physician and a signature date.