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Medicare Guidelines - Wound Care Coverage
Daily Living Assessment Surveys
Respite Care - Your First Time!
Pressure Ulcer Glossary of Terms
Wound Care Information
Skin Care & Nutrition
Pressure Ulcer (Bed Sore) Care
Wound Care: Negative Pressure Therapy
Wound Care: Nonsurgical Options
Pressure Ulcer Relief strategies
Pressure Ulcers-Preparing & Changing Dressings
Medicare Guidelines - Wound Care Coverage
Wound Care Types of Dressings
A Pressure Ulcer Assessment Tool
Using Skin Replacement Products Sensitive Pics
Social Health Maintenance Orgs (S/HMO)
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Since most insurance companies follow Medicare guidelines in establishing coverage for equipment, we have listed the Medicare Part B Coverage Criteria for Support Surfaces below:

Group 1 Product - Pressure Reducing Support Surface

A Group 1 mattress or overlay is covered under Medicare Part B if the patient meets the following criteria:
a) criterion 1, or
b) criteria 2 or 3 and at least one of criteria 4 - 7.
1) Completely immobile - i.e. patient cannot make changes in body position without assistance.
2) Limited mobility - i.e. patient cannot independently make changes in body position significant enough to alleviate pressure.
3) Any stage pressure ulcer on the trunk or pelvis.
4) Impaired nutritional status.
5) Fecal or urinary incontenence.
6) Altered sensory perception.
7) Compromised circulatory status.

Group 2 Product - Pressure Relieving Support Surface

A Group 2 support surface is covered if the patient meets the following criteria:
a) criterion 1 and 2 and 3, or
b) criterion 4, or
c) criterion 5 and 6.
1) Multiple stage II pressure ulcers located on the trunk or pelvis.
2) Patient has been on a comprehensive ulcer treatment program for at least the past month which has included the use of an appropriate group 1 support surface.
3) The ulcers have worsened or remained the same over the past month.
4) Large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis.
5) Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days). 6) The patient has been on a group 2 or 3 support surface immediately prior to a recent discharge from a hospital or nursing facility (discharge within the past 30 days).

The comprehensive ulcer treatment described in #2 above should generally include:

i) Education of the patient and caregiver on the prevention and/or management of pressure ulcers.
ii) Regular assessment by a nurse, physician, or other licensed healthcare practitioner (usually at least weekly for a patient with a stage III or IV ulcer).
iii) Appropriate turning and positioning.
iv) Appropriate wound care (for a stage II, III, or IV ulcer).
v) Appropriate management of moisture/incontinence.
vi) Nutritional assessment and intervention consistent with the overall plan of care.

Above is from National Wound Care who has the following products:

National Wound Care provides a full line of wound care equipment to aid in the prevention and treatment of pressure ulcers

Click on any of the categories listed below to view details: