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https://www.cms.gov/Medicare/Medicare-Contracting/ContractorLearningResources/downloads/JA1014.pdf
- A group 2 support surface is covered if the patient has a stage II pressure sore located on the trunk or pelvis, has been on a comprehensive pressure sore treatment program (which has included the use of an appropriate group 1 support surface for at least one month), and has sores which have worsened or remained the same over the past month.
https://www.cgsmedicare.com/jb/mr/prsspa.html
CMS is adding the following Group 2 Pressure Reducing Support Surfaces Healthcare Common Procedure Codes (HCPCS) to the required prior Authorization List: E0193, E0277, E0371, E0372, and E0373.
https://www.cgsmedicare.com/pdf/dme_checklists/grp2_support_surfaces_2018re.pdf
Recent (within the past 60 days) myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis; and The beneficiary was discharged from a hospital or nursing facility within the past 30 days; and The beneficiary was on a group 2 or 3 support surface immediately prior to the above discharge.
https://med.noridianmedicare.com/web/jddme/dmepos/pressure-reducing-support-surfaces
Pressure Reducing Support Surfaces The Standard Written Order (SWO) requirements are in effect for dates of service January 1, 2020 and after. Refer to the SWO page for the elements needed in this streamlined order.
https://med.noridianmedicare.com/documents/2230703/7218263/PRSS+Group+2+LCD+and+PA
When the stated coverage criteria for a group 2 mattress or bed are not met, a claim will be denied as not. reasonable and necessary. A support surface which does not meet the characteristics specified in the Coding Guidelines section of the Pressure. Reducing Support Surfaces – Group 2 Policy Article will be denied as not reasonable and necessary.
https://www.cgsmedicare.com/pdf/dme_checklists/grp1_support_surfaces_2018re.pdf
condition that supports the need for a group 1 pressure reducing support surface. The medical records document that the beneficiary meets ONE of the following criteria: The beneficiary is completely immobile – i.e., cannot make changes in body position without assistance.
https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-guidelines/p/pressure-reducing-support-surfaces.pdf
A beneficiary needing a pressure reducing support surface should have a care plan which has been established by the beneficiary's physician or home care nurse, which is documented in the beneficiary's medical records, and which
https://medicalpolicies.amerigroup.com/medicalpolicies/guidelines/gl_pw_a053642.htm
A pressure reducing support surface is designed to prevent or promote the healing of certain types of pressure ulcers by reducing or eliminating tissue interface pressure. Most of these devices reduce interface pressure by conforming to the contours of the body so that pressure is distributed over a larger surface area rather than concentrated on a more restricted site.
https://www.cgsmedicare.com/jc/pubs/news/2017/0117/cope1705.html
Jan 05, 2017 · Refer to the Hospital Bed and relevant Pressure Reducing Support Surface Local Coverage Determination and related Policy Article for additional information about coverage, coding and documentation requirements. For questions about correct coding, contact the Pricing, Data Analysis,...
https://med.noridianmedicare.com/web/jddme/cert-reviews/mr/pre-claim/required-programs/prior-authorization-for-prss
Due to the CMS final rule, in 2016, a Condition of Payment Prior Authorization (COPPA) process for certain DMEPOS that are frequently subject to unnecessary utilization was established. In 2019, it is expanding to include Pressure Reducing Support Surfaces (PRSS) HCPCS codes E0193, E0277, E0371, E0372, and E0373.
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