Support Surfaces
What are the different types of support surfaces? What is in Group 1, 2 and 3? CMS (Centers for Medicare and Medicaid Services) has defined three levels of horizontal support surfaces. Group 1 includes foam, gel, viscous fluid, and air overlays. Group 2 includes low air loss and alternating pressure mattresses, and Group 3 includes air-fluidized beds and some rotating/oscillating beds. Effectiveness in preventing and treating ulcers is supposed to increase with group number so a Group 2 surface is supposed to be better than a Group 1 surface.
Group 1 Pressure Reducing Support Surface
Medicare covers Group 1 Pressure Reducing Support Surfaces if the patient is bedridden, has limited movement, or has a pressure ulcer on their trunk or pelvis.
They are covered for patients that are:
- Completely immobile or
- Have limited mobility with any stage ulcer on the trunk or pelvis (and one of the following):
- impaired nutritional status
- fecal or urinary incontinence
- altered sensory perception
- compromised circulatory status
Medicare will only pay for Group 1 Pressure Reducing Support Surfaces if they are waterproof.
An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.
Some Group 1 Pressure Reducing Support Surfaces are in the Capped Rental category of DME; that means you may choose to rent or purchase a Group 1 Pressure Reducing Support Surface.
Group 2 Pressure Reducing Support Surface
A group 2 mattress overlay is covered if
- The patient has multiple stage II pressure ulcers located on the trunk or pelvis, has been on a comprehensive ulcer treatment program for at least the past month which has included the use of an appropriate group 1 support surface and the ulcers have worsened or remained the same over the past month.
- The patient has large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis.
- The patient has had recent mycutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days and the patient has been on a group 2 or 3 support surface prior to discharge from a hospital or nursing facility.
An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor. Group 2 Pressure Reducing Support Surfaces are in the Capped Rental category of DME; that means you may choose to rent or purchase a Group 2 Pressure Reducing Support Surface.
Group 3 Pressure Reducing Support Surface
Medicare covers air-fluidized beds for patients who have either thick tissue loss or certain types of severe pressure ulcers. Group 3 support surfaces considered medically necessary only if ALL of the following criteria are met:
- The individual has a stage III (full thickness tissue loss) or stage IV (deep tissue destruction) pressure sore or is status post muscle/skin flap repair of a stage III or IV pressure sore. (An air-fluidized bed is typically needed only 6-12 weeks status-post surgery.)
- The individual is bedridden or chair bound as a result of severely limited mobility and on the absence of an air fluidized bed, the individual would require institutionalization.
- The bed must have been ordered in writing by the attending physician based upon a comprehensive assessment and evaluation of the patient after conservative treatment has been tried without success. This course of conservative treatment must have been at least one month in duration without progression toward wound healing. Among other things that treatment requires frequent repositioning (usually every 2 hours), time on a group 2 support surface, necessary treatment to resolve wound infection, proper nutrition, debridement of the wound and weekly assessment.
- A trained adult caregiver is available to assist the individual with activities of daily living, and management of the wounds and the bed.
- A physician directs the home treatment regimen and re-evaluates and re-certifies the need for the air-fluidized bed every three months.
- All other alternative equipment has been considered and ruled out.
An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor. A Certificate of Medical Necessity must be completed, signed, and dated by the treating doctor.Group 3 Pressure Reducing Support Surfaces are in the Capped Rental category of DME; that means you may choose to rent or purchase a Group 3 Pressure Reducing Support Surface.
