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    v1.0.28
    OpenPayerPolicy UpdatesDurable Medical Equipment (DME)UnitedHealthcare beds safety enclosure Coverage Up…
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    CurrentUnitedHealthcarePolicy CS181ID.D

    Beds and Mattresses (for Idaho Only)

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    State-specific UnitedHealthcare medical policy governing coverage criteria for hospital beds, specialty beds, safety enclosures, and related accessories for members in Idaho, including Idaho Medicaid Plus plans.

    Policy Summary
    PayerUnitedHealthcare
    PolicyBeds and Mattresses (for Idaho Only)
    Policy CodePolicy CS181ID.D
    Change TypeMaterial edits (examples updatedfee‑schedule notation addedrestraint exclusion clarified)
    Effective DateAug 1, 2026
    Last ReviewAug 1, 2026
    Next Review Date
    Key ActionTry and document less intensive alternatives (e.g., mattress on floor, medical helmet, removal of hazards, side rails, weighted blankets) as tried and unsuccessful or contraindicated before safety enclosure is covered.
    SourceLink
    POLICY UPDATE CHANGES

    Added 'Safety Sleeper ® ' to the list of examples of safety enclosure beds.

    Removed 'Posey' from the list of examples of safety enclosure beds.

    Added notation that HCPCS codes E0265, E0266, E0296, and E0297 are not on the State of Idaho Medicaid Fee Schedule and therefore may not be covered by the State of Idaho Medicaid Program.

    Added language that enclosed bed systems are not covered when the purpose is to restrain the beneficiary due to behavioral conditions, caregiver need, or convenience.

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    IdahoApplies to
    E0316Primary HCPCS for safety enclosure
    4HCPCS codes not on ID fee schedule
    Group 2 & 3Pressure surface references

    Coverage Criteria

    Safety Enclosure Coverage Criteria

    Covered when ALL of the following are met:

    Primary clinical indications: Use of equipment is required due to a diagnosis related to cognitive impairment (e.g., traumatic brain injury, cerebral palsy, seizure disorder) or a severe behavioral disorder
    Medication optimization: Medications to address seizures and/or disruptive or harmful behaviors have been optimized or are not appropriate
    Safety risk present: There is a safety risk (examples include claustrophobia; high risk of falls due to a clinical condition; uncontrolled movements; violent or self-destructive behaviors such as uncontrolled head banging)
    Conservative measures tried: Less intensive alternative methods (e.g., mattress placed on the floor; medical helmet; removal of all safety hazards; side rails; weighted blankets) have been tried as appropriate and have not been successful or are contraindicated

    Pressure Reducing Support Surfaces

    Refer to DME MAC LCDs for Group-specific medical necessity criteria:

    Group 2 reference: For Group 2 (Low Air Loss or Powered Flotation without Low Air Loss) refer to the DME MAC LCD L33642 for medical necessity criteria.
    Group 3 reference: For Group 3 (Air-Fluidized Bed) refer to the DME MAC LCD L33692 for medical necessity criteria.

    Enclosed bed systems are explicitly not covered when the stated purpose of the equipment is to restrain the beneficiary due to behavioral conditions, to meet a caregiver’s need, or for caregiver convenience. This clarification was added to the policy to make clear that safety enclosures supplied for restraint or non‑clinical convenience do not meet medical necessity criteria.

    Use of enclosed bed systems solely for the purpose of restraint, for caregiver convenience, or for managing non‑clinical behavioral issues is considered not covered. Providers should ensure the primary intent and documentation support a clinically indicated safety need rather than caregiver convenience or behavioral restraint.

    Medical Necessity Criteria

    Safety Enclosure DME Medical Necessity

    Medical necessity for safety enclosure equipment requires ALL of the following:

    Diagnosis requirement: Diagnosis related to cognitive impairment or severe behavioral disorder
    Medication optimization: Seizure and/or behavior medications have been optimized or are not appropriate
    Documented safety risk such as claustrophobia; high fall risk due to clinical condition; uncontrolled movements; or violent/self-destructive behaviors (e.g., uncontrolled head banging)
    Alternatives tried: Less intensive alternatives (mattress on floor; medical helmet; removal of hazards; side rails; weighted blankets) have been tried and were unsuccessful or are contraindicated

    Coding

    Applicable HCPCS CodesHCPCS
    E0193Powered air flotation bed (low air loss therapy).
    E0194Air fluidized bed.
    E0250Hospital bed, fixed height, with any type side rails, with mattress.
    E0251Hospital bed, fixed height, with any type side rails, without mattress.
    E0255Hospital bed, variable height, hi-lo, with any type side rails, with mattress.
    E0256Hospital bed, variable height, hi-lo, with any type side rails, without mattress.
    E0260Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress.
    E0261Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress.
    E0265Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress.
    E0266Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, without mattress.
    1–10 of 30
    1/3
    inv-06: Weight capacity thresholds
    Codes referencedE0301–E0304 are heavy-duty/extra heavy-duty, extra wide hospital bed codes referencing weight capacity thresholds.
    >350 pounds thresholdE0301 and E0303 describe beds with weight capacity greater than 350 pounds (E0303: greater than 350 lbs but ≤ 600 lbs).
    >600 pounds thresholdE0302 and E0304 describe extra heavy-duty beds with weight capacity greater than 600 pounds.
    Related code notesThese codes are listed among applicable HCPCS codes for beds and accessories; review Idaho fee schedule status for coverage applicability.

    Provider Actions & Billing

    Prior Authorization

    Verify HCPCS codes and prior authorization requirements

    The policy lists specific HCPCS codes for beds, accessories, and safety enclosures for reference; coverage and reimbursement depend on the member’s benefit plan and applicable laws, and some listed codes may not be covered by Idaho Medicaid. Providers should verify plan coverage and prior authorization requirements for these codes before ordering.—Relevant codes include E0193, E0194, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0301–E0305, E0310, E0316, E0910, E0911, E1399.

    • Codes are provided for reference and may not be all-inclusive; listing does not imply coverage or reimbursement.
    • HCPCS codes E0265, E0266, E0296, and E0297 are not on the State of Idaho Medicaid Fee Schedule and therefore may not be covered by the State of Idaho Medicaid Program; refer to the Idaho Medicaid Provider Handbook for non-covered and excluded services.
    Step Therapy

    Try conservative measures before ordering safety enclosure

    Less intensive alternatives must be tried as appropriate and shown to be unsuccessful or contraindicated before a safety enclosure is considered medically necessary.

    Definitions

    inv-12: Safety enclosure
    DefinitionSafety enclosure: an enclosed bed frame/canopy system used with a hospital bed to prevent safety risks for individuals with cognitive impairment or severe behavioral disorder (example: Safety Sleeper®).
    Example productSafety Sleeper® is listed in the policy as an example of a safety enclosure bed.
    HCPCS codeHCPCS E0316 — Safety enclosure frame/canopy for use with hospital bed, any type.
    Coverage contextConsidered DME when used for safety related to cognitive impairment or severe behavioral disorder after less intensive measures have failed; not covered if used solely for restraint or caregiver convenience.
    inv-13: Pressure reducing support surfaces
    Definition (Group 2)Group 2 (Low Air Loss or Powered Flotation without Low Air Loss): refer to DME MAC LCD L33642 for medical necessity criteria.

    Rental and Purchase Rules

    Equipment / HCPCSRule
    Hospital bed, heavy-duty, extra wide (E0301)Refer to the State of Idaho fee schedule for determination of rental versus purchase and for fee schedule applicability; coverage and reimbursement depend on member benefit plan and applicable laws.
    Hospital bed, extra heavy-duty, extra wide (E0302)Refer to the State of Idaho fee schedule for determination of rental versus purchase and for fee schedule applicability; coverage and reimbursement depend on member benefit plan and applicable laws.
    Hospital bed, heavy-duty, extra wide (E0303)Refer to the State of Idaho fee schedule for determination of rental versus purchase and for fee schedule applicability; coverage and reimbursement depend on member benefit plan and applicable laws.
    Hospital bed, extra heavy-duty, extra wide (E0304)Refer to the State of Idaho fee schedule for determination of rental versus purchase and for fee schedule applicability; coverage and reimbursement depend on member benefit plan and applicable laws.
    Bedside rails, half-length (E0305)Refer to the State of Idaho fee schedule for determination of rental versus purchase and for fee schedule applicability; coverage and reimbursement depend on member benefit plan and applicable laws.
    Bedside rails, full-length (E0310)Refer to the State of Idaho fee schedule for determination of rental versus purchase and for fee schedule applicability; coverage and reimbursement depend on member benefit plan and applicable laws.
    Safety enclosure frame/canopy for use with hospital bed (E0316)Refer to the State of Idaho fee schedule for determination of rental versus purchase and for fee schedule applicability; coverage and reimbursement depend on member benefit plan and applicable laws.
    Trapeze bars / patient helper (E0910, E0911)Refer to the State of Idaho fee schedule for determination of rental versus purchase and for fee schedule applicability; coverage and reimbursement depend on member benefit plan and applicable laws.
    Durable medical equipment, miscellaneous (E1399)Refer to the State of Idaho fee schedule for determination of rental versus purchase and for fee schedule applicability; coverage and reimbursement depend on member benefit plan and applicable laws.
    NotesCodes marked with an asterisk (*) in the policy are not on the State of Idaho Medicaid Fee Schedule and therefore may not be covered by the State of Idaho Medicaid Program; for additional information on non-covered and excluded services, refer to the Idaho Medicaid Provider Handbook.

    Documentation Requirements

    Documentation Required

    Maintain complete, legible documentation to support medical necessity

    Medical records must document the clinical rationale for the safety enclosure: relevant history, physical examination findings, and any pertinent diagnostic test results; documentation should be legible and available on request.

    • Documentation is used to assess whether the member meets clinical criteria for coverage and does not itself guarantee coverage.
    • Maintain legible records that fully support medical necessity for reviews.

    Not Covered

    Enclosed bed systems supplied to restrain beneficiaries for behavioral control, to accommodate caregiver convenience, or for other non‑clinical reasons are not covered and are subject to denial. Documentation indicating the device is being used for restraint or convenience does not satisfy medical necessity criteria.

    Refer to the Idaho Medicaid Provider Handbook for information on non‑covered and excluded services. In addition, note that certain HCPCS codes referenced in this policy are not on the State of Idaho Medicaid Fee Schedule and therefore may not be covered by the State program; consult the handbook and the Idaho fee schedule for coverage determinations for codes such as E0265, E0266, E0296, and E0297.

    Background

    Specialty beds and safety enclosures are intended to protect individuals with altered self‑awareness or neurologic impairment from injury and falls. Examples include patients with cognitive impairment, severe behavioral disorders, or neurologic conditions that cause uncontrolled movements or high fall risk. Safety enclosures (e.g., Safety Sleeper ® coded E0316) are considered durable medical equipment when used for safety related to cognitive impairment or severe behavioral disorder after less intensive measures have failed.

    Policy Summary
    PayerUnitedHealthcare
    PolicyBeds and Mattresses (for Idaho Only)
    Policy CodePolicy CS181ID.D
    Change TypeMaterial edits (examples updatedfee‑schedule notation addedrestraint exclusion clarified)
    Effective DateAug 1, 2026
    Last ReviewAug 1, 2026
    Next Review Date
    Key ActionTry and document less intensive alternatives (e.g., mattress on floor, medical helmet, removal of hazards, side rails, weighted blankets) as tried and unsuccessful or contraindicated before safety enclosure is covered.
    SourceLink
    On This Page
    Coverage CriteriaMedical Necessity CriteriaCodingProvider Actions & BillingDefinitionsRental and Purchase RulesDocumentation RequirementsNot CoveredBackground
    • Examples of less intensive alternatives include: mattress placed on the floor, medical helmet, removal of safety hazards, side rails, and weighted blankets.
    • Documentation should show that alternatives were tried and failed or were contraindicated for the member.
    Documentation Required

    Document medical necessity in the patient record

    The patient’s medical record must contain legible documentation that fully supports medical necessity and must be made available upon request.

    • Include relevant medical history, physical examination findings, and results of pertinent diagnostic tests or procedures.
    • Document the primary diagnosis (cognitive impairment or severe behavioral disorder), optimization or contraindication of medications for seizures/behaviors, specific safety risks observed, and evidence that less intensive alternatives were tried and failed or were contraindicated.
    Denial Risk

    Do not use safety enclosures for restraint or caregiver convenience

    Enclosed bed systems used solely to restrain a beneficiary for behavioral control, caregiver convenience, or non-clinical reasons are not covered and may be denied.

    • Policy explicitly states enclosed bed systems are not covered when the purpose is to restrain the beneficiary due to behavioral conditions, caregiver need, or convenience.
    • Providers should not submit claims or request authorization if the primary purpose is restraint or caregiver convenience; refer to policy exclusions and Idaho Medicaid guidance.
    Definition (Group 3)Group 3 (Air-Fluidized Bed/Bead Bed): refer to DME MAC LCD L33692 for medical necessity criteria.
    Policy instructionFor medical necessity clinical coverage criteria for pressure reducing support surfaces, the policy directs providers to the applicable DME MAC LCDs (Group 2 and Group 3).