New Benefit – Bed Encasements

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Apple Health (Medicaid) Provider Alert

Attention Durable Medical Equipment providers:

Effective for dates of service on and after August 1, 2020, the Health Care Authority (HCA) is adding a new benefit for bed encasements.

Dust mite mattress and pillow encasements are considered medically necessary for children age 20 years and younger under the following conditions:

  • Diagnosis of persistent asthma;
  • Documented dust-mite sensitivity as demonstrated by skin testing, blood testing, or a clinical history strongly supportive of dust-mite sensitivity (such as consistent night-time congestion, cough, or wheeze in the absence of other explanation); and
  • Other indoor environmental trigger reduction efforts are being optimized.


  • Use procedure code A9286 for bed encasements. Limit one set, per client, during a five-year period.
  • Use EPA #8700016045 for mattress (twin) and EPA #870001605 for pillowcases (set of 2).
  • Complete and include with the claim HCA’s Bed and Pillow Encasements form, HCA 13-0052.
  • To download an HCA form, see HCA’s Forms & Publications webpage.

HCA will update the Medical Equipment & Supplies Billing Guide, dated August 1, 2020, to reflect this update.