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