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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2 Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.6 Durable Medical Equipment (DME) Supplier (CCP) : 2.6.12 Hospital Beds, Cribs, and Equipment

2.6.12
2.6.12.1
The following items may be considered under CCP:
Non-pediatric hospital cribs or 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:
A pediatric hospital bed or pediatric crib is defined as a fully enclosed bed with all of the following features:
A manual pediatric hospital bed (procedure code E0328) or pediatric crib (procedure code E0300) allows manual adjustment to the head and leg elevation.
A semi-electric or fully electric hospital bed (procedure code E0329) allows manual or electric adjustments to height and electric adjustments to head and leg elevation.
Pediatric hospital beds and pediatric cribs that do not have all of these features will not be considered for prior authorization.
A bed that has side rails that extend 24 inches or less above the mattress is considered a pediatric hospital bed (procedure code E0328 or E0329). A pediatric hospital bed may be fixed or variable height. Variable height beds may be adjusted manually or electrically as required for the client’s medical condition.
Procedure codes E0328 and E0329 are restricted to clients who are 20 years of age and younger.
A bed that has side rails that extend more than 24 inches above the mattress is considered a pediatric crib (procedure code E0300).
A pediatric hospital bed or pediatric crib of any width that has all of the features defined above may be considered for prior authorization using only procedure code E0300, E0328, or E0329.
Hospital beds that are not fully enclosed can be considered through Texas Medicaid home health services.
Note:
The following procedure codes are used when billing for the rental or purchase of pediatric hospital beds, cribs, and equipment:
 
* Purchase only
Note:
The purchase of a safety enclosure frame, canopy, or bubble top (procedure code E0316) may be a benefit when the protective crib top or 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 E0300, E0328, or E0329 to request a pediatric fully-enclosed bed with a canopy.
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
CPT only copyright 2014 American Medical Association. All rights reserved.