Clinicians → Coverage & Documentation · Last reviewed August 17, 2026
How to Qualify a Patient for a Pressure-Reducing Support Surface
A plain-English guide to Medicare's pressure-reducing support surface coverage — Group 1, Group 2, and Group 3 (air-fluidized) — which group the chart supports, the month that decides Group 2, and how to test for bottoming out. Based on LCDs L33830 / L33642 / L33692, Policy Articles A52489 / A52490 / A52468, and SDR A55426.
Send us three things:
- Wound + mobility note — ulcer stage, location, size (cm) + whether the patient can reposition without help.
- Care plan — if you are asking for anything above Group 1. This decides the claim.
- Standard Written Order (SWO) — 6 elements. We will prepare it.
Fax to (800) 438-2048. We tell you which group the chart currently supports.
A Group 2 surface for stage 2 ulcers requires a full documented month on a comprehensive program that failed — appropriate Group 1 surface, regular licensed assessment, turning/positioning, wound care, moisture/incontinence management, and nutritional assessment — all six, contemporaneously. Not a month of ulcer. A month of treatment. The month cannot be reconstructed after the fact.
Which group is this patient in
Group 1 — the entry criteria
A Group 1 overlay or mattress is covered if one of three is met:
Group 2 — three doors, and only one is easy
A Group 2 surface is covered if at least one of these is met:
Criterion 1 — stage 2 ulcers that failed treatment
Multiple stage 2 ulcers on trunk or pelvis which failed to improve over the past month, while on a comprehensive program that included each of:
- Appropriate Group 1 surface
- Regular assessment by nurse/practitioner/licensed clinician
- Appropriate turning and positioning
- Appropriate wound care
- Moisture and incontinence management
- Nutritional assessment and intervention
All six, for the full month, documented contemporaneously.
Criterion 2 — advanced ulcers
Large or multiple stage 3 or 4 ulcers on trunk or pelvis. No prerequisite month. Accurate staging matters — understaging a full-thickness wound costs the patient a month.
Criterion 3 — post-surgical
Myocutaneous flap or skin graft for a trunk/pelvis ulcer within 60 days, and on a Group 2 or 3 surface immediately prior to discharge within 30 days. A flap patient on a standard mattress in the hospital does not meet this. Generally limited to 60 days from surgery.
Group 3 — the air-fluidized bed
Covered only if all 8 are met — the most conditioned benefit in the library. We assess the room, floor, and panel before anything is scheduled.
Group 3 is denied outright when:
- Coexisting pulmonary disease — no firm back support, dry air thickens secretions
- Wet soaks / moist dressings not protected by impervious covering
- Caregiver unwilling or unable
- Structural support inadequate for >1,600 lb system
- Electrical system cannot handle load, or other contraindications
Medicare pays nothing toward caregiver or architectural adjustments (electrical/structural).
Step 2 — The medical record
Send the whole note. What has to be in it:
- Ulcer stage, location, size (L×W×D cm) with date — and whether on trunk or pelvis
- Mobility: independent repositioning, assisted, or none
- Severity of any risk condition — not just its name
- Care plan: turning schedule, wound care, nutrition, moisture management, who assesses + how often
- Group 2 stage 2: month of dated entries showing program + no improvement
- Group 2 flap: operative date + surface before discharge
- Group 3: caregiver + home assessment + monthly practitioner's statement
Supplier statements and attestations are not sufficient even when signed — and for Group 2/3 it must have been written as the month happened. Diagnosis codes are checked against the Policy Article's covered ICD-10 list.
Step 3 — The Standard Written Order (SWO)
We must have a completed SWO before we bill. Six elements:
- Patient name or MBI
- Order date
- Description — "powered pressure reducing mattress" or HCPCS or brand/model — order the group, not the brand
- Quantity
- Treating practitioner name or NPI
- Practitioner signature — stamps not accepted
- Product coding is ours — PDAC Product Classification List controls which products bill under E0371/E0373; tell us the clinical requirement and we pick a product that codes correctly
We will draft it. Send wound note + care plan; we fax back an SWO ready for signature. Fax (800) 438-2048.
The hard part — bottoming out
Every surface must actually work — the patient must not bottom out. Definition and test are precise enough to do at the bedside.
The test — outstretched hand, palm up, under the mattress beneath the bony prominence (coccyx or trochanter). If you can readily palpate the bone, the patient is bottoming out.
Baseline
Shifts load to sacrum
Loads trochanter — fails first
A surface that passes flat and fails at 30° is wrong — a stage 2 sacral ulcer that will not close is often bottoming out under a patient who sits up all day. Do the test before writing the escalation. Tell us weight + usual position — height specs (2″ gel, 3″ air, 5″ mattress) exist to prevent bottoming out at load.
For stage 2, there is a failed month to wait. Instead:
- Start the Group 1 surface + program today — turning, wound care, nutrition, moisture, licensed assessment. Write it.
- Document weekly with measurements. At day 30 you need a comparison.
- Call us at day 21 — we stage paperwork so Group 2 goes out the day the month closes.
- Stage accurately — stage 3/4 has no waiting period; understaging costs a month. And do not order Group 2 for an improving stage 2.
What the specifications mean
Codes are defined by measurable characteristics — a product that misses one is coded down or denied. Heavy-duty/bariatric versions have no separate codes (included in E0193/E0277/E0371/E0372/E0373/E0194).
What does not qualify
Denied as not reasonable & necessary
- Group 1 with independent repositioning + no ulcer
- Risk condition named without severity
- Group 2 stage 2 without failed month
- Group 2 improving stage 2; Group 2 beyond 60 days post-flap; air-fluidized with pulmonary disease / no caregiver / inadequate structure
Non-covered
- Foam overlay/mattress without waterproof cover — A9270 (not DME)
- Caregiver services for air-fluidized bed
- Electrical/structural improvements to the home
Which equipment the patient gets
Keeping coverage in place
What happens after we deliver
- Rental: Monthly rental — continued need must hold up each month. Confirm terms before delivery.
- When ulcer heals: Group 2 comes out unless patient independently qualifies at Group 1 on immobility — many do.
- SNF: Facility supplies surface during stay.
- Changing suppliers / MA → Medicare: First claim is new initial claim including qualifying history; proof of delivery even for a surface already in the home.
Referral checklist
Fax to (800) 438-2048 or call (800) 977-3002
- Ulcer stage + location + size with date; trunk/pelvis identified
- Mobility status — independent / assisted / none
- Severity of any risk condition — not just its name
- Care plan: turning, wound care, nutrition, moisture, licensed assessment
- Group 2 stage 2: full month of dated entries + no improvement; Group 2 flap: op date + prior surface
- Group 3: all 8 criteria + contraindications ruled out + caregiver + home assessment
- SWO signed — no stamp; ordering by group/requirement, not brand
- Ongoing wound measurements will be sent to us
Sources: LCD L33830 — Group 1; LCD L33642 — Group 2; LCD L33692 — Group 3; Policy Articles A52489 / A52490 / A52468; Standard Documentation Requirements A55426. Last reviewed August 17, 2026.
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