Pressure Reducing Support Surfaces

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Educational Resources

Coverage

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	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

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

Articles	Source	Posted
Common Denial for Hospital Beds and Accessories		05/16/2024
How to Bill for Hospital Beds and Pressure Reducing Support Surfaces		10/04/2023

DME Jurisdiction D

Pressure Reducing Support Surfaces - JD DME

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