CORRECT CODING – BARIATRIC PRESSURE REDUCING SUPPORT SURFACES
DME MAC Joint Publication
The DME MAC Pressure Reducing Support Surfaces LCDs (PRSS Groups 1-3) and related Policy Articles include a variety of products including mattress pads/overlays, mattresses, and complete beds. Questions occasionally arise about how to code bariatric versions of PRSS mattresses and mattress pads.
Most of the mattress pad/overlay and mattress PRSS codes are covered when used on a covered hospital bed frame and when the applicable reasonable and necessary (R&N) criteria described in the relevant PRSS Group 1 – 3 LCDs are met.
Per the Hospital Bed LCD, bed frames are grouped based upon three weight categories:
- Up to 350 pounds
- From 350 to 600 pounds (heavy duty)
- Greater than 600 pounds (extra heavy duty)
The mattress and mattress pad/overlay PRSS HCPCS code descriptors and PRSS LCD related Policy Article Coding Guidelines do not make distinctions based upon beneficiary weight. For Medicare billing purposes, the PRSS HCPCS codes are considered all-inclusive i.e., applicable to all beneficiary weights. The provided PRSS item must be appropriate for the beneficiary’s weight (avoids “bottoming out”), provide comparable weight capacity to match that of the provided hospitable bed frame, and must be appropriately sized to correctly fit on the provided bed frame or underlying mattress for pads/overlays. For example; a powered pressure reducing air mattress provided for a 250 lb., 400lb., or 650 lb. beneficiary all would be correctly coded as E0277 (POWERED PRESSURE REDUCING AIR MATTRESS) despite the individual products being of differing sizes, differing construction, etc.
Refer to the applicable Pressure Reducing Support Surface (Groups 1-3) LCDs and the related Policy Articles for additional information about coverage, coding and documentation.
For questions about correct coding, contact the Pricing, Data Analysis, and Coding (PDAC) contractor at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form at https://www.dmepdac.com/
Published by Noridian as the PDAC, July 2017. Republished by Palmetto GBA as the PDAC, January 2019.