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 equipmentPrior authorization form 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