Getting a Hospital Bed Covered: What to Put in Your Note (So It Doesn’t Bounce Back)

Tried getting a hospital bed approved? You know the drill: denials, “need more info,” and a dozen faxes later. The fix: front-load your documentation with the exact elements payers look for.

First: Who’s Most Likely to Qualify?

(Examples—not exhaustive. Coverage is payer-specific.)

• COPD with orthopnea/aspiration risk

• CHF requiring HOB elevation >30° most of the time

• Recurrent aspiration or severe GERD with aspiration risk

• Neurologic or musculoskeletal disease needing frequent position changes not feasible in a standard bed

• Traction required that only attaches to a hospital bed

What Insurers Expect in Your Note

Document BOTH the general need and one qualifying reason (at least one must be clearly met).

General need (include this statement):

• “Patient requires frequent body position changes and/or immediate changes in position that are not feasible with an ordinary bed.”

Plus one of the following:

1. “Patient has a medical condition requiring positioning not achievable in a regular bed (e.g., elevation, side-to-side, knee gatch), and elevating head/upper body <30° is insufficient.”

2. “Positioning in ways not feasible with an ordinary bed is required to alleviate pain.”

3. “Patient requires head-of-bed elevation >30° most of the time due to CHF/COPD/aspiration risk.”

4. “Patient requires traction equipment that can only be attached to a hospital bed.”

Tip: If HOB elevation is your primary rationale, explicitly say “>30 degrees most of the time” and why(orthopnea, nocturnal dyspnea, recurrent aspiration).

Include These Nuts-and-Bolts (or it’ll bounce)

• Face-to-face assessment date related to the DME need

• Functional limitations (e.g., can’t reposition independently; caregiver burden)

• Conservative measures tried (pillows/wedges/standard bed) and why inadequate

• Safety risks (falls, skin breakdown, aspiration)

• Estimated duration of need (e.g., ≥99 months/“lifetime” if chronic)

• Type of bed requested (standard vs. semi-electric vs. fully electric; rails) and medical reason for electric adjustment or side rails

• Home environment suitability (space, power source, caregiver able to operate)

• Follow-up/education: patient/caregiver instructed on safe use and rail entrapment precautions

EMR SmartPhrase You Can Paste

DME – HOSPITAL BED

Dx: [COPD/CHF/aspiration risk/neuromuscular dx/etc.]

The patient requires frequent body position changes and/or an immediate change in body position that are not feasible with an ordinary bed.

Qualifying reason:
[ ] Medical condition requires positioning not achievable in a regular bed; elevation <30° is insufficient.
[ ] Positioning not feasible in a regular bed is required to alleviate pain.
[ ] Requires head-of-bed elevation >30° most of the time due to [CHF/COPD/recurrent aspiration].
[ ] Requires traction equipment attachable only to a hospital bed.

Functional status: Patient is unable to reposition independently; caregiver assistance limited. Conservative measures (pillows/wedge/standard bed) were tried and are inadequate.

Request: [standard/semi-electric/fully electric] hospital bed with [full/half] rails for safety and positioning. Duration: [lifetime/≥12 months].

Home: Adequate space/power; patient/caregiver trained on safe use. Face-to-face evaluation related to DME on [DATE].

Ordering Tips (what to put on the DME order)

• Hospital bed type (standard/semi-electric/fully electric)

• Accessories: side rails (and clinical reason), over-bed trapeze if needed, low bed if fall risk

• Diagnosis codes (primary + contributing, e.g., CHF, COPD, dysphagia/aspiration)

• Length of need

• Supplier info (fax/phone), patient height/weight, contact numbers

Pearls to Reduce Denials

• Use clear clinical language, not “patient requests bed.”

• Call out “>30° HOB most of the time” or “not feasible with ordinary bed” verbatim.

• If pain is the reason, link to a specific condition (e.g., severe degenerative spine disease) and failed measures.

• If requesting electric features, state why manual cranks are unsafe or impractical (e.g., caregiver unable, patient needs immediate changes).

• Attach recent progress note + order in the same fax packet.

• Ask the DME vendor for their checklist—they know what each payer is denying this month.

Quick Diagnoses Often Used (examples)

• I50.x Heart failure

• J44.x COPD

• R13.1 Dysphagia / T17.x Aspiration—if pertinent

• M54.x / M47.x Severe spinal disease causing positional pain
  (Choose codes that truly reflect the clinical picture; follow your payer’s rules.)

Final Thoughts

Front-loading your note with these exact phrases saves you the back-and-forth. Copy the SmartPhrase, customize to the patient, and send the order + progress note together.

Questions or tricky cases? [email protected]  or DM me on social.
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