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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:
Group 2: Treatment Products
Bariatrics Systems; Bed Scales
Wheelchair Cushions/Seating
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