Item Covered Denied CMN SOP Item Information
• Water Pressure Pad and Mattress X X

Covered by Medicare if the patient is completely immobile, i.e., cannot make changes in body position without assistance, or

Limited mobility with one of the following conditions

  1. Any stage pressure ulcer on trunk or pelvis
  2. Impaired nutritional status
  3. Fecal or urinary incontinence
  4. Altered sensory perception
  5. Compromised circulatory status

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