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Medicare Qualification for Hospital Bed
- The patient’s condition requires positioning of the body; e.g., to alleviate pain, promote good body alignment, prevent contractures, avoid respiratory infections, in ways not feasible in an ordinary bed; or
- The patient’s condition requires special attachments that cannot be fixed and used on an ordinary bed.
Physician’s Prescription (Required)
The physician’s prescription, which must accompany the initial claim, and supplementing documentation when required, must establish that a hospital bed is medically necessary. If the stated reason for the need for a hospital bed is the patient’s condition requires positioning, the prescription or other documentation must describe the medical condition, e.g., cardiac disease, chronic obstructive pulmonary disease, quadriplegia or paraplegia, and also the severity and frequency of the symptoms of the condition that necessitates a hospital bed for positioning.
Will Medicare Pay?
Patient’s meeting the following criteria are eligible:
- Doctor has completed the written prescription and provided supporting medical documentation.
- Doctor has prescribed the use of a hospital bed in the home, and
- Patient has a medical condition that requires precise body positioning not possible in an ordinary bed and requires frequent repositioning.
- Patient is a Medicare beneficiary enrolled in Original Medicare (Part A and Part B).
Medical Necessity Criteria
- Variable Height Hospital Beds: The beneficiary meets coverage criteria for a fixed height hospital bed, AND The beneficiary requires a bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair or standing position.
- Severe arthritis and other injuries to lower extremities; e.g., fractured hip. The condition requires the variable height feature to assist the patient to ambulate by enabling the patient to place his or her feet on the floor while sitting on the edge of the bed;
- Severe cardiac conditions. For those cardiac patients who are able to leave bed, but who must avoid the strain of “jumping” up or down;
- Spinal cord injuries, including quadriplegic and paraplegic patients, multiple limb amputee and stroke patients. For those patients who are able to transfer from bed to a wheelchair, with or without help; or
- Other severely debilitating diseases and conditions, if the variable height feature is required to assist the patient to ambulate.
- Semi-electric Hospital Beds: The beneficiary meets coverage criteria for a fixed height hospital bed; AND The beneficiary requires frequent changes in body position and/or has an immediate need for a change in body position.
- Heavy Duty Extra Wide Hospital Beds: The beneficiary meets coverage criteria for a fixed height hospital bed (see above); AND The beneficiary’s weight is more then 350 pounds but does not exceed 600 pounds.
- Extra Heavy-duty Hospital Beds: The beneficiary meets coverage criteria for a fixed height hospital bed; AND The beneficiary’s weight exceeds 600 pounds.
- Total Electric Hospital Beds: Total electric hospital beds are not covered since the height adjustment feature is a convenience feature. Claims for total electric beds will be denied as not reasonable and necessary.
- Low Air Loss Mattresses: Low Air Loss Mattresses are categorized by Medicare as a pressure ulcer treatment product. They can also serve the preventative goal of halting the advanced staging of pressure ulcers. It is important to note that patients must have a pressure ulcer on the trunk, pelvis, or buttocks in order to qualify for a low air loss mattress.
Reputable Hospital Bed Manufacturers
- Medicare pays for 80%, Member pays 20%.
- Range: $500 – $10,000 (depending on features & size).
- Manual (non-electric): Starts from $500.
- Semi-electric: Starts from $1,000.
- Electric: Starts from $2,000.
- Mattress pad: Starts from $100.
- Overhead trapeze bars: Starts from $100.
- Bed rails: Starts from $75.
- IV poles: Starts from $50.
- Buying USED: Starts from $300.
- RENTING: Starts from $200/mo. – some companies charge additional set-up costs (additional $50+).
Adjustable Beds Frames
Adjustable bed frames made for consumers can make good alternatives to hospital beds. Consult with your doctor or medical professional about using one for your medical condition. If you do not need the bed to raise/lower and only need the head and legs to move, then an adjustable bed frame may be a good alternative. They work with most mattresses (but you should check with the manufacturer). We recommend purchasing one from a reputable brand or company – an extended warranty is better. You should avoid online retailers from unknown brands as these products have motors that can break (see list below).
- Leggett & Platt (Top Pick)
- Ergomotion (Top Pick)
- Reverie (Top Pick)
- Mattress Firm
- Sleep Number