Key facts for NCD 280.7
- Benefit category
- Durable Medical Equipment
- Effective date
- This is a longstanding national coverage determination. The effective date of this version has not been posted.
- Transmittal
- Transmittal 36
- Versions published
- 1
- Manual chapter
- 280
- NCD Manual (Pub. 100-03)
TL;DR
NCD 280.7 sets Medicare's national policy for hospital beds under the benefit category "Durable Medical Equipment", effective This is a longstanding national coverage determination. The effective date of this version has not been posted.. A physician's prescription and such additional documentation as the Medicare Administrative Contractor (MAC) medical staff may consider necessary, including medical records and physicians' reports, must establish the medical necessity for a hospital bed due… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
A. General Requirements for Coverage of Hospital Beds
A physician's prescription and such additional documentation as the Medicare Administrative Contractor (MAC) medical staff may consider necessary, including medical records and physicians' reports, must establish the medical necessity for a hospital bed due to one of the following reasons:
• The patient's condition requires positioning of the body; e.g., to alleviate pain, promote good body alignment, prevent contractures, avoid respiratory infections, in ways not feasible in an ordinary bed; or
• The patient's condition requires special attachments that cannot be fixed and used on an ordinary bed.
B. Physician's Prescription
The physician's prescription, which must accompany the initial claim, and supplementing documentation when required, must establish that a hospital bed is medically necessary. If the stated reason for the need for a hospital bed is the patient's condition requires positioning, the prescription or other documentation must describe the medical condition, e.g., cardiac disease, chronic obstructive pulmonary disease, quadriplegia or paraplegia, and also the severity and frequency of the symptoms of the condition that necessitates a hospital bed for positioning.
If the stated reason for requiring a hospital bed is the patient's condition requires special attachments, the prescription must describe the patient's condition and specify the attachments that require a hospital bed.
C. Variable Height Feature
In well documented cases, the MAC medical staff may determine that a variable height feature of a hospital bed, approved for coverage under subsection A above, is medically necessary and, therefore, covered, for one of the following conditions:
• Severe arthritis and other injuries to lower extremities; e.g., fractured hip. The condition requires the variable height feature to assist the patient to ambulate by enabling the patient to place his or her feet on the floor while sitting on the edge of the bed;
• Severe cardiac conditions. For those cardiac patients who are able to leave bed, but who must avoid the strain of "jumping" up or down;
• Spinal cord injuries, including quadriplegic and paraplegic patients, multiple limb amputee and stroke patients. For those patients who are able to transfer from bed to a wheelchair, with or without help; or
• Other severely debilitating diseases and conditions, if the variable height feature is required to assist the patient to ambulate.
D. Electric Powered Hospital Bed Adjustments
Electric powered adjustments to lower and raise head and foot may be covered when the MAC medical staff determines that the patient's condition requires frequent change in body position and/or there may be an immediate need for a change in body position (i.e., no delay can be tolerated) and the patient can operate the controls and cause the adjustments. Exceptions may be made to this last requirement in cases of spinal cord injury and brain damaged patients.
E. Side Rails
If the patient's condition requires bed side rails, they can be covered when an integral part of, or an accessory to, a hospital bed.
Text reproduced from the CMS Medicare Coverage Database record for NCD 280.7 version 1. View the original on cms.gov.
Revision history
05/1989 - Moved information concerning hospital beds from section 60-9. Effective date NA. (TN 36)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 280.7
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 280.7
What does NCD 280.7 cover?
A. General Requirements for Coverage of Hospital Beds The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 280.7 take effect?
The current version (1) is effective This is a longstanding national coverage determination. The effective date of this version has not been posted., published in transmittal 36. This is the only published version.
Does a Local Coverage Determination override NCD 280.7?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.