Items include, but not limited to the following:
Hospital Bed – Semi-Electric and Low Beds:
Common Diagnoses: Quadriplegia – unspecified (344.0), Parkinson’s (322.0), Lung Cancer (162.9), COPD
(496), CHF (428.0), Osteoarthrosis (715.0) and any other diagnosis requiring special body positioning.
Insurance Standard:
· Semi-electric beds are covered if one of the following four criteria are met:
1. Patient requires positioning of the body in ways not feasible with an ordinary bed for at least 30 days; or
2. Patient requires positioning of the body in ways not practical with an ordinary bed to alleviate pain; or
3. Patient requires the head of the bed to be elevated greater than 30 degrees most of the time due to CHF,
COPD or problems with aspiration. Pillows and wedges must have been considered and ruled out; or
4. Patient requires traction equipment and one of the following:
- A bed height different than a fixed height bed to accommodate transfers.
- Frequent changes in body position with an immediate need for change in position.
Pressure Reducing Support Surfaces:
Common Diagnoses: Quadriplegia – unspecified (344.0), Decubes/Hip (707.04), Decubes/Buttocks (707.05),
Decubes/Trunk (707.02 – 707.03), Alzheimer’s (331.0), CHF (428.0) and a number of spinal cord injuries.
Insurance Standard: Group 1
· Patient qualifies for coverage of Group 1 pressure reducing support services if one of these three criteria are
met:
1. Patient is completely immobile (patient cannot make changes in body position without assistance); or
2. Patient has limited mobility (patient cannot make changes in body position significant enough to alleviate
pressure) PLUS one of the following:
- Impaired nutritional status
- Fecal or urinary incontinence
- Altered sensory perception
- Compromised circulatory status; or
3. Patient experiences any stage pressure ulcer on the trunk of pelvis PLUS one of the following:
- Impaired nutritional status
- Fecal or urinary incontinence
- Altered sensory perception
- Compromised circulatory status.
Insurance Standard: Group 2
· Patient qualifies for coverage of Group 2 pressure reducing support services if one of these three criteria are
met:
1. Patient experiences multiple stage II pressure ulcers located on the trunk or pelvis.
- Patient has to have been on a comprehensive ulcer treatment program for at least the past month
which included the sue of an appropriate Group 1 support service.
- The ulcers have to be worse or the same over the past month.
2. Patient has had a recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis
(surgery within the past 60 days).
- Patient has to have been on a Group 2 support surface immediately prior to a recent discharge from
a hospital or nursing facility (discharge within the past 30 days).
3. Patient has large or multiple stage III or IV pressure ulcers on the trunk or pelvis.
Other Considerations:
· Group 1 includes Alternating Pump and Pad, Gel Overlay and Therapeutic Foam.
· Group 2 includes Low Air Loss Mattresses, alternating pressure reduction with low air loss.
· All support surfaces require a detailed written order prior to delivery.
Hospital Bed – Semi-Electric and Low Beds:
Common Diagnoses: Quadriplegia – unspecified (344.0), Parkinson’s (322.0), Lung Cancer (162.9), COPD
(496), CHF (428.0), Osteoarthrosis (715.0) and any other diagnosis requiring special body positioning.
Insurance Standard:
· Semi-electric beds are covered if one of the following four criteria are met:
1. Patient requires positioning of the body in ways not feasible with an ordinary bed for at least 30 days; or
2. Patient requires positioning of the body in ways not practical with an ordinary bed to alleviate pain; or
3. Patient requires the head of the bed to be elevated greater than 30 degrees most of the time due to CHF,
COPD or problems with aspiration. Pillows and wedges must have been considered and ruled out; or
4. Patient requires traction equipment and one of the following:
- A bed height different than a fixed height bed to accommodate transfers.
- Frequent changes in body position with an immediate need for change in position.
Pressure Reducing Support Surfaces:
Common Diagnoses: Quadriplegia – unspecified (344.0), Decubes/Hip (707.04), Decubes/Buttocks (707.05),
Decubes/Trunk (707.02 – 707.03), Alzheimer’s (331.0), CHF (428.0) and a number of spinal cord injuries.
Insurance Standard: Group 1
· Patient qualifies for coverage of Group 1 pressure reducing support services if one of these three criteria are
met:
1. Patient is completely immobile (patient cannot make changes in body position without assistance); or
2. Patient has limited mobility (patient cannot make changes in body position significant enough to alleviate
pressure) PLUS one of the following:
- Impaired nutritional status
- Fecal or urinary incontinence
- Altered sensory perception
- Compromised circulatory status; or
3. Patient experiences any stage pressure ulcer on the trunk of pelvis PLUS one of the following:
- Impaired nutritional status
- Fecal or urinary incontinence
- Altered sensory perception
- Compromised circulatory status.
Insurance Standard: Group 2
· Patient qualifies for coverage of Group 2 pressure reducing support services if one of these three criteria are
met:
1. Patient experiences multiple stage II pressure ulcers located on the trunk or pelvis.
- Patient has to have been on a comprehensive ulcer treatment program for at least the past month
which included the sue of an appropriate Group 1 support service.
- The ulcers have to be worse or the same over the past month.
2. Patient has had a recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis
(surgery within the past 60 days).
- Patient has to have been on a Group 2 support surface immediately prior to a recent discharge from
a hospital or nursing facility (discharge within the past 30 days).
3. Patient has large or multiple stage III or IV pressure ulcers on the trunk or pelvis.
Other Considerations:
· Group 1 includes Alternating Pump and Pad, Gel Overlay and Therapeutic Foam.
· Group 2 includes Low Air Loss Mattresses, alternating pressure reduction with low air loss.
· All support surfaces require a detailed written order prior to delivery.