Group 1 products are designed to be placed on top of a standard hospital bed or home mattresses. They can utilize gel, foam, water or air, and are covered if you are:
Completely immobile OR
Have limited mobility or 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
Group 2 products take many forms, but are typically powered pressure reducing mattresses or overlays. They are covered if you have one of three conditions:
Multiple stage II ulcers on the pelvis or trunk while on a comprehensive treatment program for at least a month using a Group 1 product, and at the close of that month, the ulcers worsened or remained the same. (Monthly follow-up is required by a clinician to ensure that the treatment program is modified and followed. This product is only covered while ulcers are still present.) OR
Large or multiple Stage III or IV ulcers on the trunk or pelvis (Monthly follow-up is required by a clinician to ensure that the treatment program is modified and followed. This product is only covered while ulcers are still present.) OR
A recent myocutaneous flap or skin graft for an ulcer on the trunk or pelvis within the last 60 days where you were immediately placed on Group 2 or 3 support surface prior to discharge from the hospital and you have been discharged within the last 30 days.
A physician or healthcare provider must make monthly assessments as to whether continued use of the equipment is required. Sometimes your physician or healthcare provider may order a home healthcare nurse to come visit you to make these assessments.
Medicare will only pay for the rental of a Group 2 product until your ulcers completely heal. If your ulcers have healed you must return the equipment to your supplier or make arrangements to pay for future monthly rentals privately using an Advance Beneficiary Notice (ABN).
Group 3 products are air-fluidized beds and are only covered if you meet ALL of the following conditions:
A stage III or stage IV pressure ulcer, and
Are bedridden or chair bound as the result of limited mobility, and
In the absence of an air-fluidized bed would require institutionalization, and
An alternate course of conservative treatment has been tried for at least one month without improvement of the wound, and
All other alternative equipment has been considered and ruled out.
A physician or healthcare provider must assess and evaluate you after completion of a course of conservative therapy within one month prior to ordering the Group 3 support surface.
A trained adult caregiver must be available to assist you. Medicare does not cover the cost of hiring a caregiver, or for structural modifications to your home to accommodate this equipment.
Your supplier cannot deliver these products to you without a written order from your doctor or healthcare provider, nor can they get the documentation at a later date because if they do, Medicare can never make payment for those products to you or your supplier. So please be patient with your supplier while they collect the required documentation from your physician or healthcare provider.
** Some or all of the products in this category may be subject to competitive bidding depending on where you live. Ask your supplier for details.