Medicare Part B Coverage Criteria for Therapeutic Mattresses

Did you know…you may qualify for a pressure reducing mattress or mattress overlay through Medicare or your insurance? If you use a wheelchair, you may also benefit from a pressure management product while in bed. Pressure reducing mattresses and overlays are therapeutic devices designed to assist in prevention and treatment of pressure wounds and provide comfort and relief to promote pain management.

NuMotion are providers of group I and group II therapeutic support mattresses. To find out if you may qualify, we have provided an overview of the Medicare Part B, medical qualifications which most insurances also require to pay for this type of device. If you believe you meet these qualifications, click on the "contact us" link, and we'll arrange for a trained Assistive Technology Professional to discuss with you the best option to fit your individual needs. Or, if you don't have insurance and just want to purchase your new therapeutic mattress today, "click here" to view all the different types of mattresses, we provide.

Group I mattress or mattress overlay is covered if the client meets one of the following scenarios:

Scenario 1:

• The patient is completely immobile (i.e. patient cannot make changes in body position without assistance).

 Scenario 2:

• Limited mobility, OR any stage pressure ulcer on the trunk or pelvis, AND at least one of the following:

               - Impaired nutritional status

               - Fecal or urinary incontinence

               - Altered sensory perception

               - Compromised circulatory status

 

Group II support surface is covered if the patient meets one of the following scenarios:

Scenario 1:

• Multiple stage II pressure ulcers located on the trunk or pelvis, AND

• Patient has been on a comprehensive ulcer treatment program for at least the past month which has included the use of an appropriate group 1 support surface, AND

• The ulcer has worsened or remained unchanged over the past month.

 Scenario 2:

• Large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis

 Scenario 3:

• Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days), AND

• The patient has been on a group 2 or 3 support surface immediately prior to a recent discharge from a hospital or nursing facility (discharge within the past 30 days)

 


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