Suppliers must bill the appropriate HCPCS code for the hospital bed frame without mattress plus the HCPCS code for the mattress-type PRSS. New, initial rental of both a hospital bed and PRSS: Combination hospital bed and mattress codes and a PRSS must not be billed at initial issue. The supplier may bill for the appropriate HCPCS code for the PRSS provided. A new capped rental does not begin with the change in hospital bed HCPCS code. The hospital bed frame without mattress rental payments will resume in the capped rental cycle in the month following discontinuation of the hospital bed with mattress. Only then may the supplier change the HCPCS code being billed to the corresponding HCPCS code for the hospital bed frame without a mattress. In this scenario, the regular mattress must be returned to the supplier and the supplier must stop billing the HCPCS code for the combination bed with mattress. Hospital bed with mattress currently in a capped rental: Providing a mattress-type PRSS to replace an existing mattress is allowed if there is a change in the beneficiary's medical condition that justifies coverage of the PRSS. Since the beneficiary owns the regular mattress, it is their decision regarding the disposition of the regular mattress. There are several possible billing scenarios:īeneficiary-owned hospital bed with mattress: Providing a mattress-type PRSS to replace an existing mattress is allowed if there is a change in the beneficiary's medical condition that justifies coverage of the PRSS. Refer to the list below for the relevant HCPCS codes for mattress-type PRSS and hospital beds with included mattresses. Suppliers must not bill HCPCS codes for two types of mattresses concurrently. The DME MACs remind suppliers that billing a hospital bed with mattress in conjunction with a mattress-type support surface (i.e., not a support surface mattress overlay) is considered to be a claim for duplicate items (same/similar). Recently there have been questions about the billing of hospital beds at the same time as a mattress-type pressure reducing support surface (PRSS).
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