Does E0270 require prior authorization?

No, E0270 does not require prior authorization (high confidence). Covered without prior authorization.

Backwork Sign up free

`E0270`, Hospital bed, institutional type includes: oscillating, circulating and stryker

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

For bedside rails/safety enclosures: documentation that member is at risk for falls or climbing out of bed, or has conditions such as seizures, vertigo, disorientation, or neurological disorders that require rails.
For bed-confined accessories (bed pans, urinals, trapeze): documentation that the member is bed-confined and the clinical reason for the accessory (e.g., need to sit up because of respiratory condition, change body position, or get in/out of bed).
For replacement mattresses on member-owned hospital beds: documentation that condition requires replacement mattress (innerspring or foam rubber).

Medical record documentation demonstrating that member meets one or more of the listed medical necessity criteria for a hospital bed (e.g., need for special positioning not feasible in ordinary bed; need for head-of-bed elevation >30 degrees most of the time for CHF/chronic pulmonary disease/aspiration).

Key Coverage Criteria

The member's condition requires positioning of the body (e.g., to alleviate pain, promote good body alignment, prevent contractures, or avoid respiratory infections) in ways not feasible in an ordinary bed.
The member's condition requires special attachments (e.g., traction equipment) that can only be attached to a hospital bed cannot be fixed and used on an ordinary bed.
The member 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 must have been considered.)
Fixed height hospital bed: medically necessary when the member meets any of the general hospital bed criteria above.
Semi-electric hospital bed: medically necessary if the member meets one of the criteria for a fixed height bed and requires frequent changes in body position and/or has an immediate need for a change in body position (semi-electric = manual height adjustment; electric head and leg elevation).
Heavy duty extra wide hospital bed: medically necessary if the member meets one of the criteria for a fixed height hospital bed and the member's weight is more than 350 pounds, but does not exceed 600 pounds.

6 Active Policies

HUMANA-MEDICAL-SUPPLIES-EQUIPMENT-AND-APPLIANCES-DURABLE-MEDICAL-EQUIPMENT-VA-MEDICAID, Medical Supplies, Equipment and Appliances Durable Medical Equipment

AETNA-CPB-0543, Hospital Beds and Accessories

BCBSIL-DME101.001, Hospital Beds and Related Equipment

BCBSMT-DME101.001, Hospital Beds and Related Equipment

BCBSNM-DME101.001, Hospital Beds and Related Equipment

BCBSOK-DME101.001, Hospital Beds and Related Equipment

`E0270`, Hospital bed, institutional type includes: oscillating, circulating and stryker

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

E0270, Hospital bed, institutional type includes: oscillating, circulating and stryker

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

`E0270`, Hospital bed, institutional type includes: oscillating, circulating and stryker