The staging of pressure ulcers used in the Medicare Coverage criteria is as follows:

Stage 1: Non-blanchable erythema of intact skin
Stage 2: Partial thickness skin loss involving epidermis and/or dermis
Stage 3: Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but through, underlying facia
Stage 4: Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures.

Patients needing pressure reducing support surfaces should have a care plan which has been established by the patient's physician or home care nurse, and is documented in the patient's medical records, and generally include the following:

• Education of patient and caregiver on the prevention and/or management of pressure ulcers
• Regular assessment by a nurse, physician or other licensed health care practitioner
• Appropriate turning and and positioning
• Appropriate wound care (for stage 2, 3, and 4 ulcer)
• Appropriate management of moisture and incontinence
• Nutritional assessment and intervention consistent with the overall care plan

Group 1 - Medicare Coverage Criteria

A group 1 mattress overlay or mattress is covered if the patient meets:

• Criteria 1, or Criteria 2 or 3 and at least one of Criteria 4 - 7 of the following:

1. Completely immobile - i.e. patient can no make changes in body position without assistance
2. Limited mobility - i.e. patient can not 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 incontinence
6. Altered sensory perception
7. Compromised circulatory status

(Required Documentation: Written Order Prior to Delivery, CMN)

Group 2 - Medicare Coverage Criteria

A group 2 support surface is covered if the patient meets:

• Criteria 1 and 2 and 3, or Criteria 4, or Criteria 5 and 6 of the following:

1. Multiple stage 2 pressure ulcers 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 appropriate group 1 support surface
3. The ulcers have worsened or remained the same over the past month
4. Large or multiple stage 3 or 4 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 3 support surface immediately prior to a recent discharge from a hospital or nursing facility (discharge within the past 30 days)

(Required Documentation: Written Order Prior to Delivery, CMN)