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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.4 Durable Medical Equipment (DME) Supplier (CCP) : 2.4.12 Hospital Beds, Cribs, and Equipment

2.4.12
2.4.12.1
The following items may be considered under CCP:
Non-pediatric hospital cribs/enclosed beds can be considered through Texas Medicaid (Title XIX) Home Health Services.
The items listed above may be a benefit for clients who are CCP-eligible when documentation submitted clearly shows that the equipment is medically necessary and will correct or ameliorate the client’s disability or physical or mental illness or condition. Hospital beds, cribs, and equipment are a benefit when all the following criteria are met:
The following procedure codes are used when billing for the rental or purchase of pediatric hospital beds, cribs, and equipment:
Note:
Procedure code E1399 may be used for reflux slings or pediatric hospital beds or cribs that fail to meet the HCPCS criteria described above for procedure codes E0300, E0328, or E0329.
The purchase of a safety enclosure frame/canopy/bubble top (procedure code E0316) may be a benefit when the protective crib top/bubble top is for safety use. It is not considered a benefit when it is used as a restraint or for the convenience of family or caregivers.
Procedure code E0316 may be used in conjunction with procedure codes E0328 or E0329 to request a pediatric fully-enclosed bed with a canopy.
Fully-enclosed is defined as four side enclosures and a top cover. A hospital bed with side rails that extend greater than 24 inches above the mattress spring is considered a crib.
Enclosed bed systems that are not approved by the Food and Drug Administration (FDA) are not a covered benefit.
Reflux slings or wedges may be considered for clients who are birth through 11 months of age. Reflux slings or wedges may be used as positioning devices for infants who require elevation after feedings when prescribed by a physician as medically necessary and appropriate.
Procedure code E0190 with modifier UD must be used to bill the purchase of reflex wedges and positional devices (positioning pillows and cushions). This code and modifier will require manual pricing. Procedure code E0190 is limited to once per three years, per client, any provider.
Procedure code K0739 may be reimbursed for the repair of equipment.

Texas Medicaid & Healthcare Partnership
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