March 20, 2026

In accordance with the Texas Medicaid Provider Procedures Manual, in the Durable Equipment, Medical Supplies, and Nutritional Products requirements section, language was updated for hospital beds and equipment, effective Jan. 1, 2026. The updated notice has revised criteria specific to safety enclosures for pediatric hospital beds. These updates on safety enclosures don’t apply to traditional hospital beds. Answers to questions we’ve received are below.

Can pediatric hospital beds already approved but not meeting the revised criteria be delivered after Jan. 1, 2026?  

Prior authorization requests approved for the effective date will be honored and related claims will be paid. New requests not meeting the revised criteria will not be approved.

Will Blue Cross and Blue Shield of Texas consider prior authorization requests on a case-by-case basis when the primary need for the pediatric hospital bed is for safety?

We will only consider prior authorization requests on a case-by-case basis if there’s a medical need for a specific bed that can’t be met by a traditional pediatric hospital bed with a safety enclosure.

Since Hospital beds used primarily for safety are non-covered, will the Safety Enclosure for a Pediatric Hospital Bed (E0316) be considered non-covered or will BCBSTX review on a case-by-case basis? 

The updated notice is specific to pediatric hospital  beds, not to safety enclosures used with a traditional hospital bed. 

Whom do I contact if I have questions about a safety enclosure for a pediatric hospital bed?

If you have questions about a safety enclosure, contact the Texas Medicaid and Healthcare Partnership. Or email our Medicaid Provider Network Team.

For more information, refer to the TMPPM Durable Equipment, Medical Supplies, and Nutritional Products Handbook, section 2.2.14.2, Pediatric Hospital Bed. 

If you have additional questions, email our Medicaid Provider Network Team or call 855-212-1615 for assistance.

The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit, and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.