Medicare Guidelines for Group II Support Surfaces

A Group II support surface (E0277) is covered if the patient meets the following criteria:

    A)  Criterion 1 and 2 and 3, or

    B)  Criterion 4, or

    C)  Criterion 5 and 6.

1) Multiple stage II pressure ulcers located on the trunk or pelvis (ICD-9 707.02 - 707.05).

2) 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.

3) The ulcers have worsened or remained the same over the past month.

4) Large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis (ICD-9 707.02 - 707.05).

5) Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days) (ICD-9 707.02 -707.05).

6) 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).

The comprehensive ulcer treatment described in #2 above should generally include:

I) Education of the patient and caregiver on the prevention and/or management of pressure ulcers.

II) Regular assessment by a nurse, physician or other licensed healthcare practitioner (usually at least weekly for a patient with a stage III or IV ulcer).

III) Appropriate turning and positioning.

IV) Appropriate wound care (for a stage II, III, or IV ulcer)

V) Appropriate management of moisture/incontinence.

VI) Nutritional assessment and intervention consistent with the overall plan of care.

When a group 2 surface is covered following a myocutaneous flap or skin graft, coverage generally is limited to 60 days from the date of surgery.

Continued use of a group 2 support surface is covered until the ulcer is healed or, if healing does not continue, there is documentation in the medical record to show that: (1) other aspects of the care plan are being modified to promote healing or (2) the use of the group 2 support surface is medically necessary for wound management.

When the stated coverage criteria for a group 2 mattress or bed are not met, a claim will be denied as not medically necessary unless there is clear documentation which justifies the medical necessity for the item in the individual case. A group 2 support surface billed without a KX modifier (see Documentation section) will usually be denied as not medically necessary.

*For coverage through Medicaid, all of the above must be met in addition to obtaining documentation on the stage, location, length, width and depth of each ulcer.

** Medicaid also requires prior authorization before this item can be dispensed.