[Regina]

Does anyone know if a patient has to be in a hospital bed to qualify for an APP or gel mattress? Can they be used on a regular bed? I read the LCD but am still unsure.

[HEATHER]

No they do not.

[Regina]

Thanks Heather!

[HEATHER]

You're welcome. And just an fyi - while the app and gel pad can be used on a regular bed - the APM/LAM cannot. I don't think a claim would be denied but it is unsafe per the manufacturer.

[Acemed]

I have always thought that Medicare will pay for the gel mattress or APP only it they have a medicare supplied hospital bed but I never bordered to check. What is the reasoning behind this payment?

[HEATHER]

There is no bed requirement mentioned in the Group 1 LCD. It is for people who have issues with pressure relief no matter what type of bed they sleep on. We have provided these without a bed since we opened in '96. We don't do a lot of gel pad overlays due to complaints about the gel moving creating a "hole."

The LCD for the group 2 support surfaces also makes no mention of a hospital bed, however I have been told by the manufacturer's that they do not recommend use of APM/LAM with a regular bed because it is too high and becomes unstable.

[Regina]

Does the same go for seat cushions? We get requests for them for a regular chair sometimes.

[HEATHER]

No, definitely not. If the patient does not have a covered wheelchair, then the cushion will be denied as not medically necessary. Cushions are not covered for use with a transport chair, rollabout chair, newer code for pwc with a captain seat (old codes like K0010 are ok) or a scooter. If we didn't provide the w/c, and therefore know medicare has made payment - then we contact the IVR to make sure they show a covered, eligible w/c on file before we provide a cushion. Also, don't know why, but the IVR (same and similar hcpc lookup) will not tell you if a previous cushion is on file - you have to call a CSR to be certain - even then it is open to human error.

http://www.cms.gov/mcd/viewlcd.asp?l...on=47&show=all

[Regina]

Thanks Heather! You are a font of useful information.