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January 5, 2017

Hospital Beds and Pressure Reducing Support Surfaces – Billing Instruction

Joint DME MAC Article

Recently there have been questions about the billing of hospital beds at the same time as a mattress-type pressure reducing support surface (PRSS). The DME MACs remind suppliers that billing a hospital bed with mattress in conjunction with a mattress-type support surface (i.e., not a support surface mattress overlay) is considered to be a claim for duplicate items (same/similar). Suppliers must not bill HCPCS codes for two types of mattresses concurrently. Refer to the list below for the relevant HCPCS codes for mattress-type PRSS and hospital beds with included mattresses. There are several possible billing scenarios:

Beneficiary-owned hospital bed with mattress: Providing a mattress-type PRSS to replace an existing mattress is allowed if there is a change in the beneficiary's medical condition that justifies coverage of the PRSS. Since the beneficiary owns the regular mattress, it is their decision regarding the disposition of the regular mattress. The supplier may bill for the appropriate HCPCS code for the PRSS provided.
Hospital bed with mattress currently in a capped rental: Providing a mattress-type PRSS to replace an existing mattress is allowed if there is a change in the beneficiary's medical condition that justifies coverage of the PRSS. In this scenario, the regular mattress must be returned to the supplier and the supplier must stop billing the HCPCS code for the combination bed with mattress. Only then may the supplier change the HCPCS code being billed to the corresponding HCPCS code for the hospital bed frame without a mattress. The hospital bed frame without mattress rental payments will resume in the capped rental cycle in the month following discontinuation of the hospital bed with mattress. A new capped rental does not begin with the change in hospital bed HCPCS code. The supplier may bill for the appropriate HCPCS code for the PRSS provided.
New, initial rental of both a hospital bed and PRSS: Combination hospital bed and mattress codes and a PRSS must not be billed at initial issue. Suppliers must bill the appropriate HCPCS code for the hospital bed frame without mattress plus the HCPCS code for the mattress-type PRSS.

The following list of HCPCS codes and descriptors detail the Group 1 and Group 2 mattress-type PRSS and the hospital beds that include mattresses:

Group 1 Support Surface Mattress Codes
E0184	DRY PRESSURE MATTRESS
E0186	AIR PRESSURE MATTRESS
E0187	WATER PRESSURE MATTRESS
E0196	GEL PRESSURE MATTRESS

Group 2 Support Surface Mattress Codes
E0193	POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY)
E0277	POWERED PRESSURE-REDUCING AIR MATTRESS
E0373	NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS

Fixed Height Beds with Mattresses Codes
E0250	HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITH MATTRESS
E0290	HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITH MATTRESS
E0328	HOSPITAL BED, PEDIATRIC, MANUAL, 360 DEGREE SIDE ENCLOSURES, TOP OF HEADBOARD, FOOTBOARD AND SIDE RAILS UP TO 24 INCHES ABOVE THE SPRING, INCLUDES MATTRESS

Variable Height Beds with Mattresses Codes
E0255	HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITH MATTRESS
E0292	HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITH MATTRESS

Semi-Electric Beds with Mattresses Codes
E0260	HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE RAILS, WITH MATTRESS
E0294	HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS, WITH MATTRESS
E0329	HOSPITAL BED, PEDIATRIC, ELECTRIC OR SEMI-ELECTRIC, 360 DEGREE SIDE ENCLOSURES, TOP OF HEADBOARD, FOOTBOARD AND SIDE RAILS UP TO 24 INCHES ABOVE THE SPRING, INCLUDES MATTRESS

Total Electric Beds with Mattresses Codes
E0265	HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE SIDE RAILS, WITH MATTRESS
E0296	HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS). WITHOUT SIDE RAILS, WITH MATTRESS

Refer to the Hospital Bed and relevant Pressure Reducing Support Surface Local Coverage Determination and related Policy Article for additional information about coverage, coding and documentation requirements.

For questions about correct coding, contact the Pricing, Data Analysis, and Coding (PDAC) contractor at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form at https://www.dmepdac.com/ External Website .

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

Hospital Beds and Pressure Reducing Support Surfaces – Billing Instruction

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