Medicare Billing for Pressure Reducing Support Surface (Group 1)

Medicare covers a variety of Durable Medical Equipment (DME) items, including pressure reducing support surfaces. These surfaces are designed to minimize the risk of pressure ulcers, also known as pressure sores. Pressure ulcers are caused by unrelieved pressure on the skin and can lead to damage of the underlying tissue. By using a pressure reducing support surface, patients can help prevent the development of these painful and potentially serious lesions. Atlantic Healthcare Products is experienced in Medicare billing for these types of items, and we can take care of all the documentation requirements. We work closely with patients, doctors, and Medicare to make sure that all coverage criteria are met. If you or a loved one is in need of a pressure reducing support surface, please don't hesitate to contact us for more information.

Download and Print the Medicare's Coverage criteria for a pressure reducing support surface.  Criteria and Medical Justification must be met for coverage.         

Save time by filling out our basic patient information form. All we need is patient name, date of birth, contact information, address, insurance information and a brief description of what you are looking for.  Once we receive your information, we will get the process started before you get to the store.  Click on Get Pre-Qualified below to get started.

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.

 

Gel Overlay Documentation Requirements for Medicare

 

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) 

A.  Impaired nutritional status 

B.  Fecal or urinary incontinence 

C.  Altered sensory perception 

D.  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)

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

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Need a Pressure Reducing Support Surface, Gel Overlay or Low Air Loss Mattress Today?

A pressure reducing support surface is used to relieve pressure and help prevent the formation of pressure sores on the body.  We carry gel overlays , alternating pressure pump and pad to help reduced pressure.  If you are not sure if this is the right item for you, or needed for a short period of time; we also have Low Air Loss Mattresses for Rent and Alternating Pressure Pad and Pump for Rent.

Is a Pressure Reducing Support Surface Covered by Medicare?

Atlantic Healthcare Products is experienced in providing Medicare billing for pressure reducing support surfaces. As a type of durable medical equipment (DME), pressure reducing support surfaces are used to relieve pressure and prevent the formation of pressure sores. We understand the documentation requirements needed to ensure that Medicare's coverage criteria are met. In addition, we work with patients, doctors, and Medicare to make sure that the correct DME is provided for each individual case. By working with us, you can be assured that you will receive the correct pressure reducing support surface for your needs. 

West Palm Beach: 561-964-6767

Boynton Beach: 561-733-2331