Support Surfaces

 
Note:  The following coverage criteria is for Medicare, other insurances may have different criteria and may be less stringent.  In most cases, meeting Medicare criteria will meet all other criteria’s.

• A written signed and dated prescription is required before a support surface is covered by Medicare.
• The face to face notes must describe the conditions for coverage as described below.
• For Group 2 support surfaces, a prior authorization is required prior to dispensing.

The staging of pressure ulcers used in the Medicare Coverage criteria is as follows:

• Stage 1: Non-blanch able erythema of intact skin
• Stage 2: Partial thickness skin loss involving epidermis and/or dermis
• Stage 3: Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but through, underlying fascia
• Stage 4: Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures.

Patients needing pressure reducing support surfaces should have a care plan which has been established by the patient's physician or home care nurse, and is documented in the patient's medical records, and generally include the following:

• Education of patient and caregiver on the prevention and/or management of pressure ulcers
• Regular assessment by a nurse, physician or other licensed health care practitioner
• Appropriate turning and positioning
• Appropriate wound care (for stage 2, 3, and 4 ulcer)
• Appropriate management of moisture and incontinence
• Nutritional assessment and intervention consistent with the overall care plan

Group 1 Options

• Alternating pressure pad w/ pump
• Dry pressure mattress Gel pressure overlay for mattress
• Air pressure mattress
• Water pressure mattress
• Gel pressure pad Air pressure overlay for mattress
• Water pressure overlay for mattress
• Dry pressure overlay for mattress 

Group 2 Options

• Low Air Loss Therapy Bed - powered Alternating pressure reducing mattress