Pressure Reducing Support Surfaces - JD 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 [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Pressure Reducing Support Surfaces - Group 2 [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Pressure Reducing Support Surfaces - Group 3 [PDF] - Continued Coverage - 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 [PDF] Letter may be sent to clinicians to assist in obtaining documentation
- Clinician Letter - Medical Records [PDF] - Letter may be sent to clinicians to assist in obtaining documentation
- Group 1 Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
- Group 2 Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
- Group 3 Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required 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 |
|
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. |