• The patient’s full name and address
• Description of the product, with the start date and length of need (in months)
• Physician’s signature and date (no date stamps allowed)

Additionally, Medicare requires the treating physician to certify that the patient meets the coverage criteria listed below:

1. Multiple stage II pressure ulcers located on the trunk or pelvis, and
2. The patient has been on a comprehensive ulcer treatment program for at least the past month which has included the use of an appropriate Group I support surface, and
3. The ulcers have worsened or remained the same over the past month, or
4. Large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis, or
5. Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days), and
6. The patient has been on a Group II or III support surface immediately prior to a recent discharge from a hospital or nursing facility (discharge within the past 30 days).

Medicare patients should also be on a care plan established by the physician or home care nurse.

Ongoing Coverage Criteria
Medicare coverage continues until the ulcer is healed or, if healing does not continue, the medical record documents that:

(1) other aspects of the care plan are being modified to promote healing, or
(2) the use of the surface is medically necessary for wound management.

For additional information on Medicare coverage for Support Surfaces, please consult the Medicare Coverage Policy.

This summary is not intended to be all-inclusive and should not be relied on for final coverage determinations.  Specific DMERC, Medicaid or Health Plan coverage policies should be reviewed prior to making any coverage determinations.   Additional criteria may be required for coverage of eligible patients depending on individual circumstances.   The information contained in this website is provided for informational purposes only and represents no statement, promise or guarantee by KCI concerning the levels of reimbursement, payment, calculations, eligibility, charge or that these policies and codes will be appropriate for specific services or products provided or that reimbursement will be made.  Information is current as of the date of publication and is subject to change at anytime.  KCI recommends that you consult your local CMS contracted carrier, Medicaid carrier or other applicable payor organization with regard to specific reimbursement policies, coverage, documentation, payment and criteria.  Individual circumstances and situations may vary.