Pressure Reducing Support Surfaces - Group 1 - Policy Article

Group 1 pressure-reducing support surfaces are covered under the DME benefit when reasonable and necessary per the related LCD and when the beneficiary has a documented care plan addressing pressure ulcer prevention/management. Specific product technical characteristics and a durable waterproof cover for foam products are required; Final Rule 1713 requires a face-to-face encounter and a Written Order Prior to Delivery for specified HCPCS codes or the claim will be denied. Suppliers must use appropriate modifiers (KX/GA/GZ), retain supporting documentation, and include detailed narratives for miscellaneous codes such as E1399.

"Pressure-reducing support surfaces (Group 1) are covered under the Durable Medical Equipment benefit when they are reasonable and necessary as defined by the related Local Coverage Determination (L..."

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