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Take the Prior Authorization Survey

Pressure Reducing Support Surfaces

Coverage

Documentation

Reviews/Audits

  • Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review

Prior Authorization Timelines

Policy Initial Review
Decision Timeframe
Expedited Review
Decision Timeframe
PAR Decision Valid
PRSS 5 business days 2 business days one month

 

Tips

Topic Detail
Group Two 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.
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 Feb 19 , 2024

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