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The beneficiary requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain, or.Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed, or The beneficiary has a medical condition which requires positioning of the body in ways not feasible with an ordinary bed.

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Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD.įor the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity.Ī fixed height hospital bed (E0250, E0251, E0290, E0291, and E0328) is covered if one or more of the following criteria (1-4) are met:.

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Refer to the Supplier Manual for additional information on documentation requirements.

The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section.

The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section.

In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The purpose of a Local Coverage Determination (LCD) is to provide information regarding “reasonable and necessary” criteria based on Social Security Act § 1862(a)(1)(A) provisions. Not endorsed by the AHA or any of its affiliates.Ĭoverage Indications, Limitations, and/or Medical Necessityįor any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements. Presented in the material do not necessarily represent the views of the AHA. Preparation of this material, or the analysis of information provided in the material. The American Hospital Association (the 'AHA') has not reviewed, and is not responsible for, the completeness orĪccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the

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Resale and/or to be used in any product or publication creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions Īnd/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is onlyĪuthorized with an express license from the American Hospital Association.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. AHA copyrighted materials including the UB‐04 codes andĭescriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may beĬopied without the express written consent of the AHA. All rights reserved.Ĭopyright © 2023, the American Hospital Association, Chicago, Illinois. The AMA assumes no liability for data contained or not contained herein.Ĭurrent Dental Terminology © 2022 American Dental Association. The AMA does not directly or indirectly practice medicine or dispense medical services. Applicable FARS/HHSARS apply.įee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not AMA CPT / ADA CDT / AHA NUBC Copyright StatementĬPT codes, descriptions and other data only are copyright 2022 American Medical Association.