Medicare will help pay for a hospital bed at home only when your medical records show you need one. The rules come from the coverage policy Medicare’s equipment contractors use, LCD L33820. Here they are in plain English, with what your records need to show. Your practitioner decides whether you meet them.
The four basic criteria
A fixed-height hospital bed is covered if one or more of these is true (LCD L33820):
- Positioning. You have a medical condition that requires positioning your body in ways that aren’t feasible with an ordinary bed. The policy adds that raising the head or upper body less than 30 degrees doesn’t usually require a hospital bed.
- Pain relief. You need positioning that isn’t feasible with an ordinary bed in order to relieve pain.
- Head elevation. You need the head of the bed raised more than 30 degrees most of the time because of congestive heart failure, chronic pulmonary disease, or problems with aspiration.
- Traction. You need traction equipment that can only be attached to a hospital bed.
Medicare defines an ordinary bed as one “typically sold as furniture,” which may or may not have head or leg adjustment (A52508). So criteria 1 and 2 are about needs that a regular bed, even an adjustable one, can’t meet.
Extra requirements by bed type
| Bed type | Example codes | Requirement on top of the basic criteria |
|---|---|---|
| Fixed height | E0250, E0251, E0290, E0291, E0328 | None |
| Variable height (manual crank) | E0255, E0256, E0292, E0293 | You need a bed height different from a fixed-height bed to transfer to a chair, wheelchair, or standing position |
| Semi-electric (electric head and leg, manual height) | E0260, E0261, E0294, E0295, E0329 | You need frequent changes in body position, or have an immediate need for a change in position |
| Heavy duty extra wide | E0301, E0303 | You weigh more than 350 lb but no more than 600 lb |
| Extra heavy duty | E0302, E0304 | You weigh more than 600 lb |
| Total (full) electric | E0265, E0266, E0296, E0297 | Not covered. The policy calls powered height “a convenience feature” |
Source: LCD L33820. Your supplier chooses the exact code.
If you want a full-electric bed, you can still get one as an upgrade by signing an Advance Beneficiary Notice and paying the difference. See semi-electric vs full-electric.
Real-life situations, mapped to the criteria
These examples show how the criteria work. They aren’t a guarantee of coverage; what counts is what your practitioner documents.
| Situation | Criterion it may relate to | What the records would need to show |
|---|---|---|
| Can’t breathe comfortably lying flat because of heart failure or COPD | 3. Head elevation | Head raised more than 30 degrees most of the time, and the diagnosis |
| Frequent choking or aspiration risk when lying down | 3. Head elevation | Aspiration problems requiring elevation most of the time |
| Severe pain that eases only in positions a regular bed can’t provide | 2. Pain relief | The positions needed and why an ordinary bed can’t provide them |
| Needs to change position often or quickly, such as to relieve breathing or pain | Semi-electric add-on | Frequent or immediate need for position changes |
| Needs a higher or lower bed to get to a wheelchair or stand | Variable-height add-on | Why a fixed-height bed won’t allow safe transfers |
| Weighs over 350 lb | Heavy-duty add-on | Current weight, plus one of the basic criteria |
What your medical records need
The policy is about documentation. Your practitioner’s notes should describe your condition and explain why you need a hospital bed and that particular type. It helps to tell your practitioner specifically what you can’t do in your current bed: for example, how high you need to sit to breathe, how often you need to change position, or how you get in and out.
Suppliers add a KX modifier to the claim only when all of the coverage criteria are met; if they expect a denial, they must use a different modifier (A52508). That’s why a supplier may ask for your records before delivery.
The order and the face-to-face visit
- Written order. Every bed needs a written order from your treating practitioner with your name or Medicare number, a description of the item, the quantity if applicable, the order date, and the practitioner’s name or NPI and signature (42 CFR 410.38).
- Face-to-face visit, for some codes. CMS’s list includes E0290, E0301, and E0304 (CMS list). For these, the practitioner must have seen you, in person or by telehealth, within the 6 months before the order, and the order must reach the supplier before delivery (42 CFR 410.38).
Accessories
Medicare may also cover these when the conditions are met (LCD L33820):
- Trapeze: if you need it to sit up because of a respiratory condition, to change position for other medical reasons, or to get in or out of bed. A heavy-duty trapeze requires a weight over 250 lb.
- Side rails or a safety enclosure: when your condition requires them and they’re part of, or an accessory to, a covered bed.
- Bed cradle: when needed to keep bed coverings off the body.
- Replacement innerspring or foam mattress: for a hospital bed you own.
Bed boards and over-bed tables aren’t covered, and neither is a trapeze attached to an ordinary bed (A52508).
If you don’t meet the criteria
- Medicare will deny the claim. If the supplier expects that, it should give you an Advance Beneficiary Notice before delivery, so you can decide whether to pay yourself.
- You can appeal a denial; better documentation often matters most.
- Other routes include Medicaid, the VA, hospice, and loan programs. See free and low-cost hospital beds, or compare renting and buying.
How we researched this guide
We quoted the coverage criteria from LCD L33820 and the definitions and modifier rules from policy article A52508, and the order rules from 42 CFR 410.38 and CMS’s face-to-face list, all checked October 7, 2026. This isn’t medical or legal advice; your practitioner and supplier make the decisions for your situation.