Filter
Top Products
Invacare
®
Therapeutic Support Surfaces
Invacare
®
Therapeutic Support Surfaces
9
Medicare Coverage Criteria*
In order to qualify for a therapeutic support surface, patients must meet certain criteria.
A Group I support surface is covered if the patient meets either of the following
scenarios:
1. Completely immobile
OR
2. Limited mobility or has any stage pressure ulcer on the trunk or pelvis and has at
least one of the following:
• impaired nutritional status
• fecal or urinary incontinence
• altered sensory perception
• compromised circulatory status
A Group II support surface is covered if the patient meets one of the following
scenarios:
1. Multiple Stage II pressure ulcers located on the trunk or pelvis and
• patient has been on a comprehensive ulcer treatment program, including the use of
an appropriate Group I surface, for at least the past month
• The ulcers have worsened or remained the same.
OR
2. Large or multiple Stage III or IV pressure ulcer(s) on the trunk or pelvis.
OR
3. Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis
(surgery within the past 60 days) and patient has been on a Group II or III support
surface immediately prior to a recent discharge from a hospital or nursing facility
(discharge within the past 30 days).
Ongoing Coverage Criteria
Coverage continues until the ulcer is healed, or if healing does not continue, the medical
record documents that:
1. Other aspects of the care plan are being modified to promote healing
OR
2. The use of the surface is medically necessary for wound management.
*This information is not, nor should it be considered, billing or legal advice. Providers
are responsible for determining the appropriate billing codes and criteria when
submitting claims to the Medicare program, and should consult an attorney or other
advisor to discuss specific situations in further details.
References:
1. National Pressure Ulcer Alcer Advisory Panel
2. Understanding Pressure Ulcers and Posture, MSS Ltd.
3. Testing completed in an independent test lab. Data on file.
4. Testing completed in an independent test lab. Data on file.
06-059 9/26/06 7:59 AM Page 9