CG-DME-16 Pressure-Reducing Support Surfaces

This policy addresses pressure-reducing support surfaces (Groups 1–3), including mattress overlays, mattresses, and air‑fluidized beds for prevention/treatment of pressure injuries. A Group 1 mattress overlay or mattress is medically necessary when the patient is completely immobile (cannot change position without assistance), or when the patient has limited mobility or a trunk/pelvic pressure ulcer plus at least one risk factor: impaired nutrition, incontinence, altered sensory perception, or compromised circulatory status. Group 1 or 2 surfaces are not medically necessary when these criteria are not met, and Group 3 (air‑fluidized) beds are not medically necessary in individuals with significant pulmonary disease, when wet soaks/unprotected moist dressings are required, or when an appropriate caregiver is unavailable or unwilling.

"Use of a group 1 mattress overlay or mattress is consideredmedically necessaryif the individual meets:"