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Group 1 Support Surface - Medicare Requirements Checklist

West Palm Beach: 561-964-6767

Boynton Beach: 561-733-2331



The checklist below is derived from Medicare’s Coverage criteria for Group 1 Support Surfaces.

Without the below criteria being fully and legible documented in the physician's chart notes and Rx, Medical justification has not been met for the items requested.


Review of Face-to-Face Examination Chart Notes for Group 1 Support Surfaces


Criteria for Chart Notes for Group 1 Support Surfaces:   

▢  The examination occurred within 6 months prior to the date of the written order.

▢  The examination documents that the beneficiary was evaluated and/or treated for a condition that supports the need for a group 1 pressure reducing support surface.


Medical Justification Indicated in Chart Notes: (Beneficiary must meet 1 of the following)

1) The beneficiary is completely immobile -i.e., beneficiary cannot make changes in body position without assistance, -OR-

2) The beneficiary has limited mobility -i.e., beneficiary cannot independently make changes in body position significant enough to alleviate pressure, & at least one of the conditions A-D below:, -OR-

▢ 3) The beneficiary has any stage pressure ulcer on the trunk or pelvis, & at least one of conditions A-D below:


Conditions: (one or more must be indicated for Medical Justification 2 or 3 listed above)

•  Impaired nutritional status

•  Fecal or urinary incontinence

•  Altered sensory perception

•  Compromised circulatory status


Conditions for criteria 2 and 3 (in each case the medical record must document the severity of the condition sufficiently to demonstrate the medical necessity for a pressure reducing support surface):

Physicians: We invite you to create the Face to Face Chart note through

Medicare Compliant paperwork the first time!

Please fax your referrals and documentation to 561-290-1434

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