Pediatric Hospital Bed and Crib Benefits to Change for CCP ... - TMHP

Pediatric Hospital Bed and Crib Benefits to Change for
CCP Effective March 1, 2013
Information posted January 11, 2013
Effective for dates of service on or after March 1, 2013, benefit criteria for pediatric
hospital beds and cribs will change for the Comprehensive Care Program (CCP).
A pediatric hospital bed or pediatric crib is defined as a bed with all of the following
features:
A bed that allows adjustment of the head and foot of the bed.
o A manual pediatric hospital bed (procedure code E0328) or pediatric crib
(procedure code E0300) allows manual adjustment to the head and leg elevation.
o 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.
A headboard
A footboard
A mattress
Side rails of any type (A side rail is defined as a hinged or removable rail, board, or
panel.)
Pediatric hospital beds or 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 powered,
as required for the client’s medical condition.
Procedure codes E0328 and E0329 will be 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 will only be considered for prior authorization under procedure code E0300,
E0328, or E0329. Procedure code E0316 may be used in conjunction with procedure
code E0300, E0328, or E0329 to request a pediatric fully-enclosed bed with a canopy.
Procedure code E1399 will only be used for reflux swings.
Hospital beds that are not fully enclosed can be considered through Texas Medicaid
home health services.
Note: Texas Medicaid defines fully enclosed as having 360-degree side enclosures.

Documentation Requirements
All pediatric hospital bed and pediatric crib procedure codes may be considered for prior
authorization when the documentation submitted clearly shows that the requested bed or
crib will correct or ameliorate the client’s condition. Documentation must include at least
one of the following criteria:
The client’s medical condition requires positioning of the body in ways that are not
feasible in an ordinary bed, including, but not limited to, positioning needs to alleviate
pain.
The head of the bed must be elevated 30 or more degrees most of the time due to,
but not limited to, congestive heart failure, chronic pulmonary disease, or problems
with aspiration, and alternative measures, such as wedges or pillows, have been
attempted but have failed to manage the client’s medical condition.
Note: Texas Medicaid defines a failed measure as having no clinically significant
improvement after being introduced.
The client requires traction equipment that can be attached only to a hospital bed.
A semi-electric or fully electric hospital bed (procedure code E0329) may be considered
for prior authorization when the submitted documentation shows that the client has a
medical condition that requires frequent changes in body position or might require an
immediate change in body position to avert a life-threatening situation.
For more information, call the TMHP Contact Center at 1-800-925-9126.