PRESSURE REDUCING SUPPORT SURFACES

F2F* is REQUIRED and documentation must be provided to the supplier.

*EXCEPTION-E0181 Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty) does not require an F2F.

Valid detailed written Physician Order/Statement of Medical Necessity that contains:

- Beneficiary’s name

- Physician’s name

- Date of the order and the start date, if start date is different from the date of the order

- Clear, detailed description of the type of support surface the physician is ordering

- Physician’s signature, NPI, and signature date

GROUP 1 –Mattress overlay OR mattress

GROUP 2 –Powered OR non-powered reducing mattress

Refer to the following pages for specific information

GROUP 1 – MATTRESS OVERLAY OR MATTRESS

GROUP 2 – Powered or non-powered pressure reducing mattress