As an approved Medicare provider, National Wound Care strictly follows all Medicare guidelines and coverage criteria. Since most insurance companies follow Medicare guidelines in establishing coverage for equipment, we have listed the Medicare Part B Coverage Criteria for Support Surfaces and Negative Pressure Wound Therapy below.

For complete Medicare Guidelines and Coverage Criteria visit www.medicare.gov.

Group 2 Product - Pressure Relieving Support Surface
A Group 2 support surface is covered if the patient meets the following criteria:
criterion 1 and 2 and 3, or
criterion 4, or
criterion 5 and 6.
  1. Multiple stage II pressure ulcers located on the trunk or pelvis.
  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.
  5. Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days).
  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:
  1. Education of the patient and caregiver on the prevention and/or management of pressure ulcers.
  2. 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).
  3. Appropriate turning and positioning.
  4. Appropriate wound care (for a stage II, III, or IV ulcer).
  5. Appropriate management of moisture/incontinence.
  6. Nutritional assessment and intervention consistent with the overall plan of care.
Negative Pressure Wound Therapy
  1. Chronic Stage III or IV pressure ulcer, neuropathic ulcer, venous or arterial insufficiency ulcer, or a chronic (being present for at least 30 days) ulcer of mixed etiology (can be located anywhere on the body), that is not improving with conventional treatment methods.
  2. A complete wound therapy program has been tried or considered and ruled out prior to application of CSWDS.
  3. Also can be utilized in the continuing therapy for surgical/trauma wounds.
  4. Can be utilized even when there is no drainage present.
Group 1 Product - Pressure Reducing Support Surface
A Group 1 mattress or overlay is covered under Medicare Part B if the patient meets the following criteria:
criterion 1, or
criteria 2 or 3 and at least one of criteria 4 - 7.
  1. Completely immobile — i.e. patient cannot make changes in body position without assistance.
  2. Limited mobility — i.e. patient cannot independently make changes in body position significant enough to alleviate pressure.
  3. Any stage pressure ulcer on the trunk or pelvis.
  4. Impaired nutritional status.
  5. Fecal or urinary incontenence.
  6. Altered sensory perception.
  7. Compromised circulatory status.
Have questions? Call our intake department toll-free at 800.982.1835. We’ll be glad to answer your specific coverage questions related to this particular type of treatment.
contact@nationalwound.com