Notification



Notification Issue Date:



Medicare Advantage Policy

Title:Pressure-Reducing Support Surfaces
Policy #:MA05.025c

This policy is applicable to the Company’s Medicare Advantage products only. Policies that are applicable to the Company’s commercial products are accessible via a separate commercial policy database.


The Company makes decisions on coverage based on the Centers for Medicare and Medicaid Services (CMS) regulations and guidance, benefit plan documents and contracts, and the member’s medical history and condition. If CMS does not have a position addressing a service, the Company makes decisions based on Company Policy Bulletins. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable. Although the Medicare Advantage Policy Bulletin is consistent with Medicare’s regulations and guidance, the Company’s payment methodology may differ from Medicare.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.


This Policy Bulletin document describes the status of CMS coverage, medical terminology, and/or benefit plan documents and contracts at the time the document was developed. This Policy Bulletin will be reviewed regularly and be updated as Medicare changes their regulations and guidance, scientific and medical literature becomes available, and/or the benefit plan documents and/or contracts are changed.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's Evidence of Coverage.

Pressure-reducing support surfaces are considered medically necessary and, therefore, covered for individuals who are at high risk for developing or have developed pressure ulcers. The medical necessity criteria for each device group is defined below. The support surface provided should be one in which the individual does not "bottom out." Bottoming out is the finding that an outstretched hand, placed palm up between the undersurface of the mattress overlay or mattress and the individual's bony prominence (coccyx or lateral trochanter) can readily palpate the bony prominence. This bottoming out criterion should be tested with the individual in the supine position with their head flat, in the supine position with their head slightly elevated (no more than 30 degrees), and in the side-lying position.

GROUP 1

MEDICALLY NECESSARY
Group 1 mattress overlay or mattress (HCPCS codes A4640, E0181-E0189, E0196-E0199) is considered medically necessary and, therefore, covered, when the individual meets one or more of the following criteria:
  • The individual is completely immobile (i.e., cannot make changes in body position without assistance).
  • The individual experiences any one of the following: altered sensory perception, compromised circulatory status, impaired nutritional status, and/or incontinence (urinary or fecal) along with one of the following:
    • Limited mobility (i.e., cannot independently make changes in body position significantly enough to alleviate pressure), OR
    • A pressure ulcer (any stage) on the trunk or pelvis

NOT MEDICALLY NECESSARY
All other uses for Group 1 pressure-reducing support surfaces are considered not medically necessary and, therefore, not covered.

GROUP 2

MEDICALLY NECESSARY
A Group 2 support surface is considered medically necessary and, therefore, covered, when the individual meets one or more of the following criteria:
  • The individual has multiple stage II pressure ulcers on their trunk or pelvis and all of the following:
    • They have been on a comprehensive ulcer treatment program. This program should generally include ALL of the following components:
      • Use of an appropriate group 1 support surface
      • Regular assessment by a licensed health care professional (usually at least weekly for an individual with a stage III or IV ulcer)
      • Appropriate turning and positioning
      • Appropriate wound care (for a stage II, III, or IV ulcer)
      • Appropriate management of moisture/incontinence
      • Nutritional assessment and intervention consistent with the overall plan of care
    • Placed on an appropriate Group I support surface, for a duration of four weeks
    • The ulcer is not healing or has worsened over the four weeks.
  • The individual has large or multiple stage III or IV pressure ulcer(s) on their trunk or pelvis.
  • The individual received a myocutaneous flap or skin graft within the past 60 days to treat a pressure ulcer on their trunk or pelvis and was on a Group 2 or 3 support surface within the past 30 days prior to being discharged from a hospital or nursing facility.
    • Coverage is generally limited to 60 days from the date of surgery.

Group 2 Codes Include the Following:

A low-air-loss bed (E0193) is considered medically necessary and, therefore, covered, when the individual meets the criteria for a powered mattress (Group 2 support surface) and bottoms out on an advanced nonpowered overlay, an advanced nonpowered mattress, and a powered mattress.

A powered mattress (E0277) is considered medically necessary and, therefore, covered, when the individual meets the criteria for an advanced nonpowered mattress (Group 2 support surface) and bottoms out on an advanced nonpowered overlay and advanced nonpowered mattress.

An advanced nonpowered overlay (E0371) is considered medically necessary and, therefore covered, when the individual meets the criteria for a Group 2 support surface.

A powered air overlay (E0372) is considered medically necessary and, therefore, covered, when the individual meets the criteria for a Group 2 support surface and bottoms out on an advanced nonpowered overlay.

An advanced nonpowered mattress (E0373) is considered medically necessary and, therefore, covered, when the individual meets the criteria for an advanced nonpowered overlay (Group 2 support surface) and bottoms out on an advanced nonpowered overlay and nonpowered mattress.

Continued use of a Group 2 support surface is considered medically necessary and, therefore covered, when the individual meets one of the following criteria:
  • Until the ulcer is healed.
  • If healing does not continue, the treating licensed health care provider documents that the continued use of a Group 2 support surface is medically necessary for wound management, or other aspects of the care plan are adjusted to promote wound healing.

NOT MEDICALLY NECESSARY
All other uses for a Group 2 pressure-reducing support surface are considered not medically necessary and, therefore, not covered.

GROUP 3

MEDICALLY NECESSARY
A Group 3 air-fluidized bed (E0194) is considered medically necessary and, therefore, covered, when the individual meets all of the following criteria:
  • The individual is bedridden or chair bound as a result of severely limited mobility.
  • The individual has stage III or IV pressure ulcers.
  • The individual has failed Group II support surfaces (i.e., after more than four weeks, the ulcers are worsening or not healing).
  • The air-fluidized bed was prescribed by the treating licensed healthcare provider after a comprehensive assessment and evaluation, within one month of a request to initiate a Group 3 support surface, and after a course of conservative treatment of at least one month that is designed to optimize wound healing, and includes All of the following:
    • Frequent repositioning of the individual to relieve pressure over bony prominences (usually every two hours)
    • Use of a group 2 support surface to reduce pressure and shear forces on healing ulcers and to prevent new ulcer formation
    • Any necessary treatment to resolve an existing wound infection
    • Optimization of nutritional status to promote wound healing
    • Debridement by any means (including wet-to-dry gauze dressings), if needed, to remove devitalized tissue from the wound bed
      • Wet-to-dry dressings when used for debridement do not require an occlusive dressing. Use of wet-to-dry dressings for wound debridement, begun during the period of conservative treatment and which continue beyond 30 days, will not preclude coverage of an air-fluidized bed. Should additional debridement again become necessary while a patient is using an air-fluidized bed (after the first 30-day course of conservative treatment), that will not cause the air-fluidized bed to be denied.
    • Maintenance of a clean, moist bed of granulating tissue with appropriate moist dressings protected by an occlusive covering, while the wound heals
    • Additionally, conservative treatment may include the following components:
      • Education of the individual and caregiver on the prevention and management of pressure ulcers
      • Assessment by a licensed health care professional at least weekly
      • Appropriate management of moisture/incontinence
  • A healthcare professional--directed home treatment regimen that includes a monthly re-evaluation of the need for an air-fluidized bed.
  • The individual would require institutionalization in the absence of an air-fluidized bed.
  • The individual's home environment can accommodate the equipment.
  • A trained adult caregiver is able and willing to provide the type of care the individual requires with the use of an air-fluidized bed (e.g., assistance with activities of daily living, repositioning, dietary needs, fluid balance, skin care, prescribed treatments, recognition and management of altered mental status) and in use/management of the air-fluidized bed and its problems such as leakage.
  • The individual has no contraindications related to the use of an air-fluidized bed (e.g., coexisting pulmonary disease [the lack of firm back support makes coughing ineffective and dry air inhalation thickens pulmonary secretions]).

Continued use of a Group 3 support surface is considered medically necessary and, therefore, covered, when the licensed health care professional documents the necessity for the Group 3 support surface on a monthly basis (including the size of the ulcer, the aspects of the care plan being adjusted to promote wound healing, continued use of the bed being necessary for wound management) and one of the following criteria are met:
  • Until the ulcer is healed.
  • If healing does not continue, the treating licensed health care professional documents that the continued use of a Group 3 support surface is medically necessary for wound management, or other aspects of the care plan are adjusted to promote wound healing.

NOT MEDICALLY NECESSARY
All other uses for an air fluidized bed (E0194), including the following conditions, are considered not medically necessary and, therefore, not covered.
  • The individual has co-existing pulmonary disease (the lack of firm back support makes coughing ineffective and dry air inhalation thickens pulmonary secretions).
  • The individual requires treatment with wet soaks or moist wound dressings that are not protected with an impervious covering such as plastic wrap or occlusive material.
  • The caregiver is unwilling or unable to provide the type of care required by the member on air-fluidizing bed.
  • The structural support is inadequate to support the weight of the air-fluidized bed system (approximately 1600 lbs or more).
  • The electrical system is insufficient for the anticipated increase in energy consumption.

FACE-TO-FACE REQUIREMENTS

As a condition for payment, a professional provider must have a face-to-face examination with the individual for whom the item is ordered that meets all of the following requirements:
  • The treating professional provider must have an in-person examination with the individual within the six (6) months prior to the date of the written order prior to delivery.
  • This examination must document that the individual was evaluated and/or treated for a condition that supports the need for the item(s) of DME ordered.

A new face-to-face examination is required each time a new prescription for one of the specified items is ordered. A new prescription is required:
  • For all claims for purchases or initial rentals
  • When there is a change in the prescription for the accessory, supply, drug, etc.
  • If periodic prescription renewal required per medical policy
  • When an item is replaced
  • When there is a change in the supplier
  • When required by state law

In this policy the specified items are:

CodeNarrative
E0185Gel or gel-like pressure pad for mattress, standard mattress length and width
E0188Synthetic sheepskin pad
E0189Lambswool sheepskin pad, any size
E0194Air fluidized bed
E0197Air pressure pad for mattress, standard mattress length and width
E0198Water pressure pad for mattress, standard mattress length and width
E0199Dry pressure pad for mattress, standard mattress length and width


REQUIRED DOCUMENTATION

The Company may conduct reviews and audits of services to our members regardless of the participation status of the provider. Medical record documentation must be maintained on file to reflect the medical necessity of the care and services provided. These medical records may include but are not limited to: records from the professional provider’s office, hospital, nursing home, home health agencies, therapies, and test reports. This policy is consistent with Medicare's documentation requirements, including the following required documentation:

PRESCRIPTION (ORDER) REQUIREMENTS
Before submitting a claim to the Company, the supplier must have on file a timely, appropriate, and complete order for each item billed that is signed and dated by the professional provider who is treating the member. Requesting a provider to sign a retrospective order at the time of an audit or after an audit for submission as an original order, reorder, or updated order will not satisfy the requirement to maintain a timely professional provider order on file.

PROOF OF DELIVERY
Medical record documentation must include a contemporaneously prepared delivery confirmation or member’s receipt of supplies and equipment. The medical record documentation must include a copy of delivery confirmation if delivered by a commercial carrier and a signed copy of delivery confirmation by member/caregiver if delivered by the DME supplier/provider. All documentation is to be prepared contemporaneous with delivery and be available to the Company upon request.

CONSUMABLE SUPPLIES
The durable medical equipment (DME) supplier must monitor the quantity of accessories and supplies an individual is actually using. Contacting the individual regarding replenishment of supplies should not be done earlier than approximately seven days prior to the delivery/shipping date. Dated documentation of this contact with the individual is required in the individual’s medical record. Delivery of the supplies should not be done earlier than approximately five days before the individual would exhaust their on-hand supply

Documentation of a face-to-face encounter between the treating professional provider and the individual meeting the above requirements, including an assessment of the individual’s clinical condition supporting the need for the prescribed DME item(s), must be provided to and kept on file by the DME supplier.

If required documentation is not available on file to support a claim at the time of an audit or record request, the durable medical equipment (DME) supplier may be required to reimburse the Company for overpayments.

COLUMN I/COLUMN II REIMBURSEMENT EDITS

The reimbursement for the item(s) represented by the code(s) in column II are included in the reimbursement for the item represented by the code in column I.

Group 1 Pressure-Reducing Support Surfaces

Column I
Column II
E0181
A4640,
E0182

Policy Guidelines

An individual who needs a pressure-reducing support surface should have a documented care plan that was established by a professional provider. Treatment includes, but is not limited to:
  • Wound care appropriate to the stage of the ulcer
  • Nutritional assessment with the provision of an adequate diet and/or nutritional supplements
  • Frequent positioning
  • Management of incontinence
  • Education for the individual and caregiver on ulcer prevention and/or treatment
  • Regular assessment by a professional provider (usually at least weekly for an individual with a stage III or IV ulcer)

This policy is consistent with Medicare's coverage criteria. The Company's payment methodology may differ from Medicare.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, a pressure-reducing support surface is covered under the medical benefits of the Company’s Medicare Advantage products when the medical necessity criteria listed in this medical policy are met.

However, services that are identified in this policy as not medically necessary are not eligible for coverage or reimbursement by the Company.

Description

A pressure ulcer, also referred to as decubitus ulcer, pressure sore, or bedsore, is defined as an area of localized tissue necrosis caused by soft tissue being compressed between a bony prominence and an external surface. Pressure ulcers usually occur over bony prominences and are staged to classify the degree of tissue damage observed. If eschar is present, a pressure ulcer cannot be accurately staged until the eschar is removed. A nonhealing wound is one in which all appropriate wound management treatments have been explored but has not changed or improved in appearance or has increased in size or depth.

The staging of pressure ulcers is as follows:
  • Suspected Deep Tissue Injury: Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, or warmer or cooler as compared to adjacent tissue.
  • Stage I: Observable pressure-related alteration of intact skin with indicators, as compared to the adjacent or opposite area on the body, may include changes in one or more of the following: skin temperature (warmth or coolness), tissue consistency (firm or boggy feel), and/or sensation (pain, itching). The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.
  • Stage II: Partial-thickness skin loss involving the epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.
  • Stage III: Full-thickness skin loss involving damage or necrosis of subcutaneous tissue extending down to, but not through, the fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.
  • Stage IV: Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structure (e.g., tendon, joint capsule). Undermining and sinus tracts may also be associated with stage IV pressure ulcers.
  • Unstageable: Full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown, or black) in the wound.

A pressure-reducing support surface is a device (i.e., overlay, mattress, bed) that reduces or eliminates tissue interface pressure to help prevent ulcer formation in individuals who are completely immobile (i.e., cannot make changes in body position without assistance) or have limited mobility (i.e., cannot independently make changes in body position significantly enough to alleviate pressure). The device conforms to the contours of the body so that the pressure is distributed over a larger surface area, causing reduced or eliminated interface pressure.

PRESSURE-SUPPORT SURFACE GROUPS

Pressure-reducing support surface devices are divided into the following three groups, which is consistent with Medicare's categorization:

GROUP 1
  • A nonpowered overlay is a pad placed on top of a standard mattress that is composed of cells that may be filled with gel, air, water, or foam. The cells distribute pressure uniformly over the support area. A gel or foam overlay has a height of 2 inches or greater. An air or water overlay has a height of 3 inches or greater.
  • A powered overlay is a pad placed on top of a standard mattress that uses an air pump or blower to inflate or deflate the cells or to circulate air throughout the cells. The cell height is 2.5 inches or greater.
  • A nonpowered mattress is a foam, air, water, or gel mattress that can be placed on a hospital bed frame and has a height of at least 5 inches and a waterproof cover.

GROUP 2
  • An advanced nonpowered overlay is a pad placed on top of a standard mattress that provides more pressure reduction than a Group 1 nonpowered overlay. The overlay has a total height of 3 inches or greater, has friction or shear reduction qualities, and is usually filled with air that can be adjusted in different zones based on the individual's needs.
  • An advanced nonpowered mattress is a mattress that provides more pressure reduction than a standard nonpowered mattress, can be placed on a hospital bed frame, has a total height of 5 inches or greater, and is designed to decrease friction or shear.
  • A powered mattress is a foam mattress placed on a standard hospital bed frame that uses an air pump or blower to inflate or deflate the cells or circulate air throughout the cells of the mattress.
  • A low-air-loss bed is a semi-electric or electric bed with an integrated powered mattress. The mattress consists of a series of interconnected woven fabric air pillows that allow some air to escape through the surfaces. The pillows can be variably inflated to adjust the level of pressure relief.
  • An advanced powered mattress overlay is a low-air-loss, powered flotation bed without low-air-loss or alternating pressure. The overlay has an inflated height of 3.5 inches or greater.

GROUP 3
  • An air-fluidized bed uses a high rate of air flow to fluidize fine particulate material (e.g., sand, silicone-coated ceramic beads) to simulate the characteristics of fluid.

References

Berlowitz D. Clinical staging and management of pressure-induced injury
Last updated: July 16, 2018. In: UpToDate, Available at: http://www.uptodate.com/contents/clinical-staging-and-management-of-pressure-induced-injury [subscription may be required]. Accessed August 29, 2019.

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD) 280.8: Air-Fluidized Bed. [CMSWeb site]. 11/1/2000. Available at:https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=228&ncdver=1&bc=AgAAgAAAAAAA&. Accessed August 29, 2019.

Noridian Healthcare Solutions, LLC. Pressure Reducing Support Surfaces - Group 1 Policy Article (A52489). Original effective: 10/01/15. Revised effective: 01/01/2017. Available at:
https://www.cms.gov/medicare-coverage-database/license/cpt-license.aspx?from=~/overview-and-quick-search.aspx&npage=/medicare-coverage-database/details/article-details.aspx&articleId=52489. Accessed August 29, 2019.

Noridian Healthcare Solutions, LLC. Pressure Reducing Support Surfaces - Group 2 Policy Article (A52490). Original effective: 10/01/15. Revised effective: 05/25/2017. Available at:
https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52490. Accessed August 29, 2019.

Noridian Healthcare Solutions, LLC. Pressure Reducing Support Surfaces - Group 3 Policy Article (A52468). Original effective: 10/01/15. Revised effective: 01/01/2017. Available at:
https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52468. Accessed August 29, 2019.

Noridian Healthcare Solutions, LLC. Pressure Reducing Support Surfaces- Group 1. Local Coverage Determination (LCD). (L33830). Original effective: 10/01/15. Revised effective: 01/01/2017. Available at:
https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33830&ContrId=389. Accessed August 29, 2019.

Noridian Healthcare Solutions, LLC. Local Coverage Determination (LCD). (L33642): Pressure reducing support surfaces- Group 2. Original effective: 10/01/15. Revised effective: 05/25/2017. Available at:
https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33642&ContrId=389. Accessed August 29, 2019.

Noridian Healthcare Solutions, LLC. Pressure Reducing Support Surfaces- Group 3. Local Coverage Determination (LCD). (L33692): Original effective: 10/01/15. Revised effective: 01/01/2017. Available at:
https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33692&ContrId=389. Accessed August 29, 2019.






Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

See Attachment A.


HCPCS Level II Code Number(s)



GROUP 1 PRESSURE REDUCING SUPPORT SURFACES

A4640 Replacement pad for use with medically necessary alternating pressure pad owned by patient

E0181 Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty

E0182 Pump for alternating pressure pad, for replacement only

E0184 Dry pressure mattress

E0185 Gel or gel-like pressure pad for mattress, standard mattress length and width

E0186 Air pressure mattress

E0187 Water pressure mattress

E0188 Synthetic sheepskin pad

E0189 Lambswool sheepskin pad, any size

E0196 Gel pressure mattress

E0197 Air pressure pad for mattress, standard mattress length and width

E0198 Water pressure pad for mattress, standard mattress length and width

E0199 Dry pressure pad for mattress, standard mattress length and width


GROUP 2 PRESSURE REDUCING SUPPORT SURFACES

E0193 Powered air flotation bed (low air loss therapy)

E0277 Powered pressure-reducing air mattress

E0371 Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width

E0372 Powered air overlay for mattress, standard mattress length and width

E0373 Nonpowered advanced pressure reducing mattress


GROUP 3 PRESSURE REDUCING SUPPORT SURFACE

E0194 Air-fluidized bed


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References

Attachment A: Pressure-Reducing Support Surfaces
Description: ICD-10 Codes







Policy History

MA05.025b
11/06/2019 The policy has been reviewed and reissued to communicate the Company's continuing position on Pressure-Reducing Support Surfaces





MA05.025b
11/26/2018This version of the policy will become effective 11/26/2018. The intent of this policy has not changed, although it has been modified to incorporate the following ICD-10 CM codes and HCPCS code.

The following ICD-10 CM codes have been added to Attachment A of this policy:

L89.003, L89.004, L89.013, L89.014, L89.023, L89.024, L89.200, L89.201, L89.202, L89.203, L89.204, L89.209, L89.300, L89.301, L89.302, L89.303, L89.304, L89.309, L89.503, L89.504, L89.513, L89.514, L89.523, L89.524, L89.603, L89.604, L89.613, L89.614, L89.623 L89.624, L89.813, L89.814, L89.893, L89.894, L89.93, L89.94

MA05.025a
03/22/2017The policy has been reviewed and reissued to communicate the Company’s continuing position on pressure-reducing support surfaces.

MA05.025
03/16/2016The policy has been reviewed and reissued to communicate the Company’s continuing position on pressure-reducing support surfaces.

Existing durable medical equipment documentation requirements, in accordance with Medicare, are now included with examples.
09/16/2015The policy has been reviewed and reissued to communicate the Company’s continuing position on pressure-reducing support surfaces.

Existing durable medical equipment documentation requirements, in accordance with Medicare, are now included with examples.
01/01/2015This is a new policy.






Version Effective Date: 11/26/2018
Version Issued Date: 11/26/2018
Version Reissued Date: 11/6/2019