Bed Support Surfaces

Group 1 - Alternating pressure pads and pump & gel overlay

(E0181-E0189, E0196-E0199, and A4640)

One of the following criteria must be met:

1. Patient is completely immobile--i.e. patient cannot make changes in body position without assistance

2. Patient has limited mobility--i.e. patient cannot independently make changes in body position significant enough to alleviate pressure, and at least one of conditions listed below

3. Patient has any stage pressure ulcer on the trunk or pelvis and at least one of conditions below:

   • Impaired nutritional status
   • Fecal or urinary incontinence
   • Altered sensory perception
   • Compromised circulatory status

Medical record must document the severity of the condition sufficiently to demonstrate the medical necessity for a pressure reducing support surface.

Group 2 - Low air loss mattresses

(E0181-E0189, E0196-E0199, and A4640)

At least one of the following criteria must be met:

1. Patient has multiple stage II pressure ulcers on the trunk or pelvis, which have not improved in the past month, during which the patient has been on a comprehensive ulcer treatment program including each of the following:

   • Use of an appropriate group 1 support surface
   • Regular assessment by a nurse, physician, or other licensed healthcare practitioner
   • Appropriate turning and positioning
   • Appropriate wound care
   • Appropriate management of moisture/incontinence
   • Nutritional assessment and intervention consistent with the overall plan of care

2. Patient has large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis.

3. Patient had a myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis within the past 60 days and has been on a group 2 or 3 support surface immediately prior to discharge from a hospital or nursing facility within the past 30 days.

Coverage for group 2 surfaces following a myocutaneous flap or skin graft is generally limited to 60 days from the date of surgery.

Group 3 - Air-fluidized silicone bead beds

Criteria for coverage by US Medicare

Immobile patients with stage 3 or stage 4 pressure ulcers who

• Would require institutionalization if the device were not provided

OR

• Have previously failed therapy with a group 2 device

Monthly, detailed documentation must be submitted to US Medicare to acquire and retain Group 3 support surfaces in the home. Include the following:

• Wound care is comprehensive
• Direct wound care management with qualified staff
• Limitation of incontinence associated moisture
• Nutritional support
• Dedicated, responsive caregivers*

* N.B. Caregivers must be able to respond quickly to a malfunctioning Group 3 bed which has lost power or is leaking air. Nonfunctioning Group 3 bed systems, which become rock-hard when air is lost or non-circulating, can cause expansion of a wound in hours.