Provider Alert! Prior authorizations for hospital beds reminder and new codes added
Attention: All Providers
Effective date for new codes: August 26, 2020
Call to action: Texas Children’s Health Plan (TCHP) would like to remind you that the following hospital beds and accessories’ codes require prior authorization. This follows the guidance from the Texas Medicaid Provider Procedures Manual (TMPPM).
| Code | Description |
| E 0184 | Dry pressure mattress |
| E0185 | Gel or gel-like pressure pad for mattress, standard mattress length |
| E0186 | Air pressure mattress |
| E0187 | Water pressure mattress |
| E0188 | Synthetic sheepskin pad |
| E0189 | Lamb’s wool sheepskin pad, any size |
| E0190 | Positioning cushion/pillow/wedge, any shape or size |
| E0193 | Powered air flotation bed (low air loss therapy) |
| E0194 | Air fluidized bed |
| E0196 | Gel pressure mattress |
| E0197 | Air pressure pad for mattress, standard mattress length and width E0198 Water pressure pad for mattress, standard mattress length |
| E0198 | Water pressure pad for mattress, standard mattress length and width |
| E0199 | Dry pressure pad for mattress, standard mattress length and width |
| E0271 | Mattress, innerspring- 1 purchase every 5 years |
| E0277 | Powered pressure-reducing air mattress, 1 per month |
| E0315 | Bed accessory: board, table, or support device, any type |
| E0372 | Powered air overlay for mattress, standard mattress length |
| E0373 | Non-powered advanced pressure reducing mattress |
| E0371 | Non-powered advanced pressure reducing overlay for mattress, standard mattress length and width |
| E0912 | Trapeze bar |
| E0940 | Trapeze bar, freestanding |
New Codes that required a prior authorization effective August 26, 2020:
| Code | Description |
| E0250 | Hospital bed, fixed height, with any type side rails, with mattress- 1 purchase every 5 years; 1 per month rental |
| E0255 | Hospital bed, variable height, hi-lo, with any type side rails, with mattress – 1 purchase every 5 years; 1 per month rental |
| E0260 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress- 1 purchase every 5 years; 1 per month rental |
| E0265 | Hospital bed, total electric (head, foot, and height adjustment s), with any type side rails, with mattress- 1 purchase every 5 years; 1 per month rental |
| E0300 | Pediatric crib, hospital grade, fully enclosed, with or without top enclosure- 1 per month rental |
| E0316 | Safety enclosure frame/canopy for use with hospital bed, any type-1 per month rental |
| E0328 | Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress-1 per month rental |
| E0329 | Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring includes mattress-1 per month rental |
Reference: TMPPM hospital beds and equipment
How this impacts providers: Providers should seek approval prior to billing the previously listed codes for hospital beds.
Next steps for providers: Update their office staff of the new authorization requirements.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
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