Manual 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.

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

1. Explain why the patient’s medical condition 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 the patient requires the head of the bed to be elevated more than 30 degrees most of the time. Examples:  due to congestive heart failure, chronic pulmonary disease, or problems with aspiration. OR

4. Explain why the patient needs traction equipment attached to the hospital bed If Yes AND

5. Explain why the patient requires a bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair or standing position.

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

Medicare approved detailed equipment descriptions for Manual hospital bed
Hospital bed manual (HCPC-E0250). 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.