Invacare® Therapeutic Support Surfaces
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.
Invacare® Therapeutic Support Surfaces
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