Reimbursement
Centers for Medicare and Medicaid Services (CMS) has developed a medical coverage policy for Heavy-Duty Beds, which defines the information required to determine medical necessity. Medicare requires all of the information below before a coverage determination can be made.
If you have any further questions or comments about the reimbursement of KCI products, please email us at Reimbursement@KCI1.com.
Medicare Coverage Criteria Summary*
Medicare requires a complete physician’s order/prescription that must include:
- The patient’s full name and address
- Description of the product, with the start date and length of need (in months)
- Physician’s signature and date (no date stamps allowed)
Medicare also requires a completed Certificate of Medical Necessity, which may substitute for the physician’s order if it contains all the required elements of an order.
The patient must meet one or more of the following criteria:
- Requires positioning of the body in ways not feasible with an ordinary bed due to a medical condition
- Requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain
- Requires the head of the bed to be elevated more than 30 degrees most of the time due to specific medical conditions
- Requires traction equipment that can only be attached to a hospital bed
- Must weigh over 600 lbs
*This summary is not intended to be all-inclusive and should not be relied on for final coverage determinations. Specific DMERC, Medicaid or Health Plan coverage policies should be reviewed prior to making any coverage determinations. Additional criteria may be required for coverage of eligible patients depending on individual circumstances. The information contained in this website is provided for informational purposes only and represents no statement, promise or guarantee by KCI concerning the levels of reimbursement, payment, calculations, eligibility, charge or that these policies and codes will be appropriate for specific services or products provided or that reimbursement will be made. Information is current as of the date of publication and is subject to change at anytime. KCI recommends that you consult your local CMS contracted carrier, Medicaid carrier or other applicable payor organization with regard to specific reimbursement policies, coverage, documentation, payment and criteria. Individual circumstances and situations may vary.