For Your Comfort and Safety
Hospital Bed & Bedroom Accessories – hospital bed, bariatric hospital beds, bed trapeze, foam bed wedges, fitted hospital bed sheets, home bed assist handles, mattress pads, mattress protectors, over the bed table and trays, pillows, pressure relief pads, safety bed rails, bed rail covers, fall mats
INSURANCE Coverage on Hospital Beds
A hospital bed is covered if you have visited your doctor or healthcare provider and during an office visit your doctor or healthcare provider documents in your chart that one or more of the following criteria (1-4) are met:
1. You have a medical condition which requires positioning of the body in ways not feasible with an ordinary bed (elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed), or
2. You require positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain, or
3. You require 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. Pillows or wedges must have been considered and ruled out, or
4. You require traction equipment which can only be attached to a hospital bed.
• Specialty beds that allow the height of the bed to be adjusted are covered if you require this feature to permit transfers to a chair, wheelchair or standing position.
• A semi-electric bed is covered if your medical condition requires frequent changes in body position and/or you have an immediate need for a change in body position.
• Heavy-duty/extra-wide beds can be covered if you weigh over 350 pounds.
• The total electric bed is not covered because it is considered a convenience feature. If you prefer to have the total electric feature, your supplier usually can apply the cost of the qualifying hospital bed toward the monthly rental price of the total electric model. You will need to sign an Advance Beneficiary Notice (ABN) and will be responsible to pay the difference in the retail charges between the two items every month.
• Hospital beds are a capped rental item, and that means they cannot be purchased outright. You will own the equipment after Medicare makes 13 payments toward the purchase of the equipment.
• Depending on which product is ordered, your supplier may not be able to deliver this product to you without a written order or certificate of medical necessity from your doctor or healthcare provider, nor can they get the documentation at a later date because if they do, Medicare can never make payment for those products to you or your supplier. So please be patient with your supplier while they collect the required documentation from your physician or healthcare provider.
INSURANCE Coverage for Support Surfaces
Group 1 Products…
Are designed to be placed on top of a standard hospital bed or home mattresses. They can utilize gel, foam, water or air, and are covered if you are:
• Completely immobile OR
• Have limited mobility or any stage ulcer on the trunk or pelvis (and one of the following):
• impaired nutritional status
• fecal or urinary incontinence
• altered sensory perception
• compromised circulatory status
• Group 2 Products…
Take many forms, but are typically powered pressure reducing mattresses or overlays. They are covered if you have one of three conditions:
• Multiple stage II ulcers on the pelvis or trunk while on a comprehensive treatment program for at least a month using a Group 1 product, and at the close
of that month, the ulcers worsened or remained the same. (Monthly follow-up is required by a clinician to ensure that the treatment program is modified and followed. This product is only covered while ulcers are still present.) OR
• Large or multiple Stage III or IV ulcers on the trunk or pelvis (Monthly follow-up is required by a clinician to ensure that the treatment program is modified and followed. This product is only covered while ulcers are still present.) OR
• A recent myocutaneous flap or skin graft for an ulcer on the trunk or pelvis within the last 60 days where you were immediately placed on Group 2 or 3 support surface prior to discharge from the hospital and you have been discharged within the last 30 days.
• A physician or healthcare provider must make monthly assessments as to whether continued use of the equipment is required. Sometimes your physician or healthcare provider may order a home healthcare nurse to come visit you to make these assessments.
• Medicare will only pay for the rental of a Group 2 product until your ulcers completely heal. If your ulcers have healed you must return the equipment to your supplier or make arrangements to pay for future monthly rentals privately using an Advance Beneficiary Notice (ABN).
• Group 3 products…
Are air-fluidized beds and are only covered if you meet ALL of the following conditions:
• A stage III or stage IV pressure ulcer, and
• Are bedridden or chair bound as the result of limited mobility, and
• In the absence of an air-fluidized bed would require institutionalization, and
• An alternate course of conservative treatment has been tried for at least one month without improvement of the wound, and
• All other alternative equipment has been considered and ruled out.
• A physician or healthcare provider must assess and evaluate you after completion of a course of conservative therapy within one month prior to ordering the Group 3 support surface.
• A trained adult caregiver must be available to assist you. Medicare does not cover the cost of hiring a caregiver, or for
structural modifications to your home to accommodate this equipment.
• Your supplier cannot deliver these products to you without a written order from your doctor or healthcare provider, nor can they get the documentation at a later date because if they do, Medicare can never make payment for those products to you or your supplier. So please be patient with your supplier while they collect the required documentation from your physician or healthcare provider.
