Beds and Mattresses (for Kansas Only)
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Policy governing medical necessity and coverage references for beds and mattresses for UnitedHealthcare Community Plan members in Kansas; directs providers to the Kansas Medical Assistance Program DME Fee-For-Service Provider Manual for clinical criteria.
Added language clarifying medical records documentation requirements to support medical necessity for requested services.
Added FDA section referencing Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment.
Updated References section to reflect most current information and archived previous policy version CS181KS.01.
Coverage Criteria
Medical necessity determination
Coverage is determined by Kansas Medical Assistance Program DME Fee-For-Service Provider Manual
This policy does not list independent clinical criteria; it delegates to the state manual.
The HCPCS codes listed in this policy are provided for reference only. Listing of a code does not guarantee coverage or reimbursement, and inclusion of a code is not an indication that the service described by the code is a covered benefit. Benefit coverage is determined by federal, state, contractual requirements, and applicable law; other policies and guidelines may also affect coverage and payment.
This policy does not itself enumerate specific conditions or scenarios that are considered not medically necessary. Determinations about medical necessity, including whether an item is not medically necessary, are made according to the clinical coverage criteria in the applicable state program and related manuals rather than by this policy text.
Applicable HCPCS and Coding Details
| E0255 | Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
| E0256 | Hospital bed, variable height, hi-lo, with any type side rails, without mattress |
| E0260 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
| E0261 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
| E0265 | Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress |
| E0266 | Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, without mattress |
| E0277 | Powered pressure-reducing air mattress |
| E0280 | Bed cradle, any type |
| E0290 | Hospital bed, fixed height, without side rails, with mattress |
| E0291 | Hospital bed, fixed height, without side rails, without mattress |
| E0300 | Pediatric crib, hospital grade, fully enclosed, with or without top enclosure |
| E0301 | Hospital bed, heavy-duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress |
| E0302 | Hospital bed, extra heavy-duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress |
| E0303 | Hospital bed, heavy-duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
| E0304 | Hospital bed, extra heavy-duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress |
| E0305 | Bedside rails, half-length |
| E0310 | Bedside rails, full-length |
| E0316 | Safety enclosure frame/canopy for use with hospital bed, any type |
| E0328 | Hospital bed, pediatric, manual, 360-degree side enclosures, includes mattress |
| E0911 | Trapeze bar, heavy-duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar |
Provider Actions and Billing
Prior authorization / coding reference — follow Kansas DME manual
Coverage and billing for the HCPCS bed and mattress codes listed in this policy are subject to the Kansas Medical Assistance Program Durable Medical Equipment Fee‑For‑Service Provider Manual clinical criteria and applicable benefit terms; providers must verify and meet the state DME manual authorization requirements prior to billing.
- Applies to the HCPCS codes listed in the policy (see Coding section).
- Providers should verify authorization requirements per the Kansas DME manual before submitting claims.
Provider actions — verify state criteria and include code-specific info
Providers must submit complete, legible medical record documentation that supports medical necessity for requested beds and mattresses and follow state manual requirements; consult the Kansas DME manual and this policy's coding lists when preparing requests.
- Reference the specific HCPCS codes in the policy when requesting authorization.
- Verify state manual clinical criteria are met before ordering or billing.
Required medical records documentation
The patient's medical record must contain documentation that fully supports the medical necessity for the requested services, including relevant medical history, physical examination findings, and results of pertinent diagnostic tests or procedures; documentation should be legible, maintained in the record, and made available upon request.
- Include relevant medical history and physical exam findings specific to the need for the bed or mattress.
- Attach results of pertinent diagnostic tests or procedures that support the request.
- Ensure documentation is legible, retained in the medical record, and available upon request.
Documentation insufficiency may lead to denial
Lack of medical record documentation fully supporting medical necessity may result in denial of the requested services.
- Incomplete, illegible, or unavailable documentation at time of review increases risk of denial.
- Failure to demonstrate that state DME manual criteria are met may cause claim or authorization denial.
Background
Clinical medical necessity criteria for beds and mattresses are delegated to the Kansas Medical Assistance Program Durable Medical Equipment Fee-For-Service Provider Manual. Providers must refer to and meet the state DME manual’s clinical coverage criteria when requesting authorization or submitting claims for bed and mattress items.
Definitions and HCPCS Categories
Medical Necessity — State Criteria
State manual criteria
Refer to Kansas Medical Assistance Program DME Fee-For-Service Provider Manual for medical necessity criteria
No local criteria listed in this policy.
Rental and Purchase Rules
| Equipment | Rental vs Purchase Rule |
|---|---|
| All listed bed and mattress HCPCS (see Coding section) | |
| Refer to the Kansas Medical Assistance Program Durable Medical Equipment Fee-For-Service Provider Manual for rental versus purchase determination for all listed bed and mattress HCPCS. |
Replacement Rules
Documentation Requirements
Required — documentation must fully support medical necessity and be available on request
Medical record documentation must fully support medical necessity — including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures — and be legible, maintained in the record, and made available upon request.
- Documentation should explicitly tie clinical findings to the specific bed or mattress HCPCS code requested.
- Retain all supporting records and produce them if requested during review.
Not Covered / Limitations
There are no express local exclusions listed in this policy beyond the general statement that inclusion of a code does not imply coverage. Coverage of the listed HCPCS codes is contingent on meeting the Kansas DME manual criteria, applicable benefit terms, and contractual requirements; some listed codes may not be covered in specific circumstances.
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