Pressure Reducing Support Surfaces - Group 3

Medicare covers air-fluidized beds only when specific medical necessity criteria are met for beneficiaries with stage 3 or 4 pressure ulcers who are bedridden or chair-bound, would otherwise require institutionalization, and who have completed at least a one-month course of conservative treatment without progression toward healing. Required documentation includes a written order (SWO/WOPD), a comprehensive evaluation within one month prior to initiation, proof of the conservative treatment and weekly assessments during that period, monthly practitioner reevaluation/recertification, evidence that alternatives were considered and caregiver/home environment are adequate; several explicit contraindications (e.g., significant pulmonary disease, inadequate structural/electrical support, unprotected moist dressings, or lack of caregiver) will preclude coverage.

"Beneficiary has a stage 3 (full thickness tissue loss) or stage 4 (deep tissue destruction) pressure ulcer."