F2F is REQUIRED and documentation must be provided to supplier

Valid Physician Order/Statement of Medical Necessity that contains:

- Beneficiary’s name

- Physician’s name

- Date of the order and the start date, if start date is different from the date of the order

- Height AND weight

- Specific type of bed (semi electric or bariatric-wt. > 350 lbs.) that is to be ordered

- Each option that is separately billed

- Each accessory (trapeze) that is separately billed

- Treating physician’s signature, NPI, and signature date

Chart notes documenting that one OR more of the following criteria are met:

For fixed height bed:

- The beneficiary has a medical condition which 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 hospital bed;

- The beneficiary requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain;

- The beneficiary 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;

- The beneficiary requires traction equipment, which can only be attached to a hospital bed

For semi-electric bed:

-ALL of the above criteria plus

The beneficiary requires frequent changes in

body position and/or has an immediate need for a change in position