Support Surfaces (Low Air Loss Mattresses)

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Support Surfaces (Low Air Loss Mattresses)

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Group One – Preventive

  • These are usually a mattress overlay or a foam mattress replacement.They may be covered if a patient is completely immobile, OR has limited mobility or any stage ulcer on the trunk or pelvic along with at least one of the following:
    • Impaired nutritional status
    • Incontinence
    • Altered sensory perception
    • Compromised circulatory status

Group Two – Therapeutic

  • Usually a powered pressure reducing mattress (such as air loss, alternating pressure) that can be placed directly on a hospital bed frame.It may be covered if the patient has:
    • Multiple Stage II ulcers on trunk or pelvis, and
    • Previous month of treatment on a Group I, and ulcers that has worsened or remained the same in the past month OR
    • Large or multiple Stage II ulcers on trunk of pelvic, and
    • Recent flap or graft surgery for an ulcer on the trunk or pelvis (60 days), and
    • Previous use of a Group II or III surface immediately prior to a recent discharge from a facility (30 days).
  • Documentation – Written order and a CMN.

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