OAR 410-122-0380
Hospital Beds


(1)

Indications and limitations of coverage and medical appropriateness: The Division may cover some hospital beds for a covered condition including:

(a)

A fixed height hospital bed (E0250, E0251, E0290 and E0291) when the client meets at least one of the following criteria:

(A)

Has a medical condition that 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;

(B)

Requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain;

(C)

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. Pillows or wedges shall have been considered and ruled out;

(D)

Requires traction equipment that can only be attached to a hospital bed;

(b)

A variable height hospital bed (E0255, E0256, E0292 and E0293) when all of the following criteria are met:

(A)

Criteria for a fixed height hospital bed are met;

(B)

A bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair, or standing position is required;

(c)

A semi-electric hospital bed (E0260, E0261, E0294 and E0295) when all of the following criteria are met:

(A)

Criteria for a fixed height hospital bed are met;

(B)

Frequent changes or an immediate need for a change in body position are required;

(C)

The client is capable of safely and effectively operating the bed controls;

(d)

A heavy duty extra wide hospital bed (E0301, E0303) when all of the following criteria are met:

(A)

Criteria for a fixed height hospital bed are met;

(B)

The client weighs more than 350 pounds but less than 600 pounds;

(C)

The client is capable of safely and effectively operating the bed controls;

(e)

An extra heavy duty hospital bed (E0302, E0304) when all of the following are met:

(A)

Criteria for one of the hospital beds described in (1)(a)-(d) are met;

(B)

The client weighs more than 600 pounds;

(C)

The client is capable of safely and effectively operating the bed controls;

(D)

When provided for a nursing facility client, the bed shall be rated for institutional use;

(f)

Total electric hospital beds (E0265, E0266, E0296 and E0297) are not covered since the height adjustment feature is considered a convenience feature;

(g)

Payment Authorization: Subject to service limitations of Division rules, a hospital bed rental may be dispensed without PA only from the initial date of service through the second date of service. The durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) provider is still responsible to ensure all rule requirements are met. Payment authorization is required prior to submitting any claims to the Division regardless of the date of service, including the initial and second dates of service, and will be given once all required documentation has been received and any other applicable rule requirements have been met. Payment authorization is obtained from the same authorizing authority as specified in 410-122-0040 (Prior Authorization). Required documentation shall be received by the authorizing authority prior to the third date of service.

(2)

Documentation requirements: Submit documentation that has been reviewed, signed, and dated by the prescribing practitioner and that supports conditions of coverage as specified in this rule are met including:

(a)

For all hospital beds:

(A)

Primary diagnosis code for the condition necessitating the need for a hospital bed;

(B)

The type of bed currently used by the client and why it doesn’t meet the medical needs of the client;

(b)

For semi-electric beds: Why a variable height bed cannot meet the medical needs of the client;

(c)

For heavy duty and extra heavy duty beds: The client’s height and weight.

(3)

Table 122-0380 — Hospital Beds.
[ED. NOTE: Tables referenced are available from the agency.]
[ED. NOTE: To view attachments referenced in rule text, click here to view rule.]
410‑122‑0010
Definitions
410‑122‑0020
Orders
410‑122‑0040
Prior Authorization
410‑122‑0080
Conditions of Coverage, Limitations, and Restrictions
410‑122‑0090
Face-to-Face Encounter Requirements (for Fee-For-Service Clients)
410‑122‑0180
Healthcare Common Procedure Coding System Level II Coding
410‑122‑0182
Legend
410‑122‑0184
Repairs, Servicing, Replacement, Delivery, and Dispensing
410‑122‑0186
Payment Methodology
410‑122‑0188
DMEPOS Rebate Agreements
410‑122‑0200
Pulse Oximeter for Home Use
410‑122‑0202
Positive Airway Pressure (PAP) Devices for Adult Obstructive Sleep Apnea
410‑122‑0203
Oxygen and Oxygen Equipment
410‑122‑0204
Nebulizer
410‑122‑0205
Respiratory Assist Devices
410‑122‑0206
Intermittent Positive Pressure Breathing
410‑122‑0207
Respiratory Supplies
410‑122‑0208
Suction Pumps
410‑122‑0209
Tracheostomy Care Supplies
410‑122‑0210
Ventilators
410‑122‑0211
Cough Stimulating Device
410‑122‑0220
Pacemaker Monitor
410‑122‑0240
Apnea Monitors for Infants
410‑122‑0250
Breast Pumps
410‑122‑0260
Home Uterine Monitoring
410‑122‑0280
Heating/Cooling Accessories
410‑122‑0300
Light Therapy
410‑122‑0320
Manual Wheelchair Base
410‑122‑0325
Power Wheelchair Base
410‑122‑0330
Power-Operated Vehicle
410‑122‑0340
Wheelchair Options/Accessories
410‑122‑0360
Canes and Crutches
410‑122‑0365
Standing and Positioning Aids
410‑122‑0375
Walkers
410‑122‑0380
Hospital Beds
410‑122‑0400
Pressure Reducing Support Surfaces
410‑122‑0420
Hospital Bed Accessories
410‑122‑0475
Therapeutic Shoes for Diabetics
410‑122‑0510
Osteogenesis Stimulator
410‑122‑0515
Neuromuscular Electrical Stimulator (NMES)
410‑122‑0520
Glucose Monitors and Diabetic Supplies
410‑122‑0525
External Insulin Infusion Pump
410‑122‑0540
Ostomy Supplies
410‑122‑0560
Urological Supplies
410‑122‑0580
Bath Supplies
410‑122‑0590
Patient Lifts
410‑122‑0600
Toilet Supplies
410‑122‑0620
Miscellaneous Supplies
410‑122‑0625
Surgical Dressing
410‑122‑0630
Incontinent Supplies
410‑122‑0640
Eye Prostheses
410‑122‑0655
External Breast Prostheses
410‑122‑0658
Gradient Compression Stockings/Sleeves
410‑122‑0660
Orthotics and Prosthetics
410‑122‑0662
Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses
410‑122‑0678
Dynamic Adjustable Extension/Flexion Device
410‑122‑0680
Facial Prostheses
410‑122‑0700
Negative Pressure Wound Therapy Pumps
410‑122‑0720
Pediatric Wheelchairs
Last Updated

Jun. 8, 2021

Rule 410-122-0380’s source at or​.us