Qualifications
Therapeautic Overlays: Group 1
For a patient to qualify for a group 1 support surface they must match one of three criteria.
Criteria 1
· Patient is completely immobile |
Criteria 2
· Patient has limited mobility.
And has one of the following:
· Impaired nutritional status.
· Fecal or urinary incontinence.
· Altered sensory perception.
· Compromised circulatory status |
Criteria 3
· Any stage pressure ulcer on the trunk or pelvis.
And has one of the following:
· Impaired nutritional status.
· Fecal or urinary incontinence.
· Altered sensory perception.
· Compromised circulatory status |
|---|
Low Air Loss and
Alternating Pressure Mattresses: Group 2
For a patient to qualify for a group 2 support surface they must match one of three criteria.
Criteria 1
· Large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis. |
Criteria 2
· Multiple Stage II pressure ulcers located on the trunk or pelvis.
· Patient has been on a ulcer treatment program for at least a month with the use of an appropriate Group 1 surface.
· Ulcers have worsened or remain the same over the past month. |
Criteria 3
· Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis.
and
· Patient has been on a Group II or III support surface immediately prior to a recent discharge from hospital or nursing facility. (discharge within past 30 days) |
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Wheel Chair Cushions
Skin Protection Cushions
· E2603 (Cork Wound Care offers a wide range of skin protection cushions)
· The patient has a wheelchair and the patient meets Medicare coverage criteria for it.
· A skin protection cushion is covered it patient has current pressure ulcer (707.03, 707.04, 707.05)
or
138
330.0 - 330.9
331.0
332.0
335.0 - 335.21
335.23 - 335.9
336.0 - 336.3
340 |
Late effects of acute poliomyelitis
Cerebral degeneration in childhood
Alzheimer's disease
Paralysis agitans
Anterior horn cell disease (SMA)
Other motor neuron disease
Other diseases of the spinal cord
Multiple sclerosis |
341.0 - 341.9
343.0 - 343.9
344.00 - 344.1
707.03
707.04
707.05
741.00 - 741.93 |
Other demylelinating diseases of CNS
Infantile cerebral palsy
Quadriplegia, quadriparesis, paraplegia (lower limbs)
Decubitus ulcer (lower back)
Decubitus ulcer (hip)
Decubitus ulcer (buttock)
Spina bifida |
|---|
Skin Protection Cushions
· E2605 (Cork Wound Care offers a wide range of positioning protection cushions)
· A positioning cushion is covered if the patient has any significant postural asymmetries that are due to one of the diagnoses.
· The patient has a wheelchair and the patient meets Medicare coverage criteria for it.
and
138
330.0 - 330.9
331.0
332.0
333.4
333.6
334.0 - 334.9
335.0 - 335.21
335.23 - 335.9
336.0 - 336.3
340 |
Late effects of acute poliomyelitis
Cerebral degeneration in childhood
Alzheimer's disease
Paralysis agitans
Huntington’s chorea
Symptomatic torsion dystonia
Spinocerebellar disease
Anterior horn cell disease (SMA)
Other motor neuron disease
Other diseases of the spinal cord
Multiple sclerosis |
341.0 - 341.9
342.00 - 342.92
343.0 - 343.9
344.00 - 344.1
344.30 - 344.32
359.0
359.1
438.20 - 438.22
438.40 - 438.42
741.00 - 741.93
|
Other demylelinating diseases of CNS
Hemiplegia and hemparesis
Infantile cerebral palsy
Quadriplegia, quadriparesis, paraplegia (lower limbs)
Other paralytic syndromes (monoplegia lower limbs)
Congenital hereditary muscular dystrophy
Hereditary progressive muscular dystrophy
Hemiplegia (late effects of CVD)
Monoplegis of lower limbs (late effects of CVD)
Spina bifida |
|---|
Combonation Cushions
· E2607 (Cork Wound Care offers a wide range of combination cushions)
· A combination cushion is covered for a patient who meets the criteria for both a skin protection seat cushion and a positioning seat cushion.
Standard General Use Cushion and Back Cushions
· E2601 / E2611 (Cork Wound Care offers a wide range of general foam cushions / back cushions)
· General use seat cushion and back cushions are covered for a patient who has a wheelchair which meets Medicare coverage criteria. If the patient does not have a covered wheelchair, then the cushion will be denied as not medically necessary.