May 20, 2010
Group 3 Support Surfaces – Coverage Criteria Reminder
Recently it has come to the attention of the DME MACs that there is confusion regarding the coverage of air-fluidized bed technology (Group 3 support surfaces) for patients who have undergone surgical flap or graft procedures. Medicare does not cover air-fluidized beds in the home setting for patients with surgical grafts or flaps. Coverage for patients with these conditions is outlined in the LCD for Group 2 support surfaces. Coverage of a Group 3 support surface is limited to bed-ridden or chair-bound patients with stage III or stage IV pressure ulcers that without the use of an air-fluidized bed would be institutionalized. The LCD contains additional coverage criteria including physician oversight requirements, conservative management and other provisions related to Medicare reimbursement for these products. Suppliers and physicians are encouraged to consult the LCD for full coverage, coding and documentation requirements.