Item Covered Denied CMN SOP Item Information
• Alternating Pressure Pad & Mattress X X

If the patient is completely immobile, i.e., cannot make changes in body position without assistance, or limited mobility, or any stage pressure ulcer on the trunk or pelvis - with one of the following conditions:

  • Impaired nutritional status
  • Fecal or urinary incontinence
  • Altered sensory perception
  • Compromised circulatory status

A physician's written prescription/order must be furnished to the supplier prior to delivery (WOPD).