Pressure Reducing Support Surfaces - JA DME
Pressure Reducing Support Surfaces
Coverage
- Pressure Reducing Support Surfaces - Group 1 Local Coverage Determination (LCD)
- Pressure Reducing Support Surfaces - Group 1 Policy Article
- Pressure Reducing Support Surfaces - Group 2 Local Coverage Determination (LCD)
- Pressure Reducing Support Surfaces - Group 2 Policy Article
- Pressure Reducing Support Surfaces - Group 3 Local Coverage Determination (LCD)
- Pressure Reducing Support Surfaces - Group 3 Policy Article
Documentation
- Standard Documentation Requirements for All Claims Submitted to DME MACs
- Clinician Checklist Pressure Reducing Support Surfaces - Group 1 - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Pressure Reducing Support Surfaces - Group 2 - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Letter - Medicare Prior Authorization Condition of Payment for Group 2 - Pressure Reducing Support Surfaces Dear Clinician Letter Letter may be sent to clinicians to assist in obtaining documentation
- Clinician Letter - Medical Records - Letter may be sent to clinicians to assist in obtaining documentation
- Group 1 Documentation Checklist - Checklist to ensure suppliers gather all required documentation
- Group 2 Documentation Checklist - Checklist to ensure suppliers gather all required documentation
- Group 3 Documentation Checklist - Checklist to ensure suppliers gather all required documentation
Documentation to Include in Prior Authorization (PA) Package Submission
- PRSS PA request coversheet
- Standard Written Order (Group 2) /WOPD (Group 3)
- The WOPD must be completed within six (6) months after the required face-to-face encounter.
- Medical record documentation to support coverage criteria
- Face-to-face encounter (Group 3)
- To view the full list of items that require a F2F, please refer to Required Face-To-Face Encounter and Written Order Prior To Delivery List
- Review Pressure Reducing Support Surfaces - Group 2 Local Coverage Determination (LCD) L33642 and related Policy Article A52490 for additional details.
- Review Pressure Reducing Support Surfaces - Group 3 Local Coverage Determination (LCD) L33692 and related Policy Article A52468 for additional details.
- Documentation must be submitted to the appropriate jurisdiction based on the beneficiary's permanent address with the PA coversheet for fax, mail, or electronic submission of medical documentation (esMD). For Noridian Medicare Portal (NMP) submissions, complete all required fields in the portal as a coversheet is not required.
Prior Authorization
Tips
Group 2 - Mattress
A group 2 support surface is covered if the beneficiary meets at least one of the three criteria in the LCD with applicable ICD-10 diagnoses listed in the LCD-related Policy Article. The beneficiary's medical record should contain a care plan established by the treating practitioner or home care nurse which includes one of the criteria listed in the LCD.
Group 3 - Bed
A Group 3 support surface is covered if the beneficiary meets all coverage criteria in the LCD. The beneficiary's medical record should contain documentation supporting each required criterion, including a comprehensive treatment plan established and implemented by the treating practitioner and other applicable healthcare professionals as outlined in the LCD.
Providing a PRSS
- When Beneficiary owns Hospital Bed with mattress - Providing a mattress-type PRSS to replace an existing mattress is allowed if there is a change in the beneficiary's medical condition that justifies coverage of the PRSS. When the beneficiary owns a hospital bed with mattress, it is their decision regarding the disposition of that mattress. The supplier may bill for the appropriate HCPCS code for the PRSS provided.
- When Hospital Bed with mattress is in a capped rental period - Providing a mattress-type PRSS to replace an existing mattress is allowed if there is a change in the beneficiary's medical condition that justifies coverage of the PRSS. In this scenario, the regular mattress must be returned to the supplier and the supplier must stop billing the HCPCS code for the combination bed with mattress.
Billing Instruction - Hospital Beds and Pressure Reducing Support Surfaces
Please refer to the Billing Instruction - Hospital Beds and Pressure Reducing Support Surfaces DMD joint article.
Last Updated Oct 01 , 2026
