Item Covered Denied CMN SOP Item Information
• Low Air-Loss Bed




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Covered by Medicare if the following conditions are met:

  1. Criteria 1, 2 and 3, or
  2. Criterion 4, or
  3. Criteria 5 and 6.
    1. Multiple Stage II pressure ulcers located on the trunk or pelvis.
    2. Patient has been on a comprehensive ulcer treatment program for at least the past month which has included the use of an appropriate Group I Support Surface.
    3. The ulcers have worsened or remained the same over the past month.
    4. Large or multiple Stage III or IV pressure ulcer(s) (see below) on the trunk or pelvis.
    5. Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days). Coverage is generally limited to 60 days from the date of surgery.
    6. The 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).
      Stage I:Nonblanchable erythema of intact skin
      Stage II:Partial thickness skin loss involving epidermis and/or dermis
      Stage III:Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia
      Stage IV:Full thickness skin loss with extensive destruction, tissue necrosis damage to muscle, bone or supporting structures

Coverage is limited to the low-air loss bed itself. A physician's written prescription/order for the bed must be furnished to the supplier prior to delivery of the bed (WOPD).

Caregiver services and any electrical or structural improvements to the patient's room are not covered.