Emerg Auto-Emersion Therapy System and Dolphin Fluid Immersion Simulation System for Pressure Injury
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Defines AmeriHealth Caritas coverage stance for the Emerg Auto-Emersion Therapy and Joerns Dolphin Fluid Immersion Simulation support surfaces used to prevent or treat pressure injuries; applies to prior authorization and medical necessity determinations for members covered by AmeriHealth Caritas plans.
No material clinical or coverage changes in this revision.
Coverage Determination
Not covered (investigational)
Covered when ALL of the following are met:
Policy conclusion is based on limited and low-quality evidence, including one small manufacturer-sponsored randomized trial of the Dolphin system and a lack of comparative studies across product classes.
The Emerg® Auto-Emersion Therapy® system and the Joerns® Dolphin Fluid Immersion Simulation® system are excluded from coverage for the prevention or treatment of pressure injuries because they are considered investigational / not medically necessary.
Use of the Emerg Auto-Emersion Therapy system and the Joerns Dolphin Fluid Immersion Simulation system to prevent or treat pressure injuries is considered not medically necessary. These devices have been judged investigational due to limited and low-quality evidence and are not an approved or supported therapeutic option for pressure-injury prevention or treatment under this policy.
Coding and Billing Codes
| E1399 | Durable medical equipment, miscellaneous |
Provider Actions and Billing Expectations
Prior authorization expected to be denied
These devices are considered investigational and not medically necessary; prior authorization requests for the Emerg Auto-Emersion Therapy System and the Joerns Dolphin Fluid Immersion Simulation System are expected to be denied or will require justification consistent with the investigational determination.
Use covered alternative support surfaces first
Before considering these investigational systems, use covered alternative support surfaces such as non-powered or powered pressure-reducing mattresses and mattress overlays, and other immersive support surfaces (for example, high-specification foam mattresses and air-fluidized therapy mattresses).
- Non-powered pressure-reducing mattresses
- Powered pressure-reducing mattresses
- Mattress overlays
- High-specification foam mattresses
- Air-fluidized therapy mattresses
Coding guidance — bill appropriate DME codes
Bill using appropriate durable medical equipment (DME) HCPCS codes for support surfaces; E1399 (Durable medical equipment, miscellaneous) is listed as a commonly submitted code for items subject to this policy and may be used where appropriate.
- Consult coding manuals and bill the specific DME code that describes the item
- E1399 — Durable medical equipment, miscellaneous (commonly submitted)
Denial risk — investigational / not medically necessary
Claims for the Emerg Auto-Emersion Therapy System and the Joerns Dolphin Fluid Immersion Simulation System will be denied as investigational/not medically necessary when billed for prevention or treatment of pressure injuries.
Clinical Background
Pressure injuries are localized damage to skin and underlying soft tissue that typically develop over bony prominences due to prolonged pressure, shear, and friction and are associated with immobility, moisture, impaired perfusion, malnutrition, and sensory loss. Support surfaces are one component of prevention and treatment strategies because they help redistribute pressure; these include reactive (static) surfaces that change load distribution in response to applied load and active (dynamic) surfaces that mechanically redistribute pressure through sequential alterations. Newer fluid immersion simulation systems aim to simulate full immersion/envelopment to redistribute pressure, but available evidence for the Emerg and Dolphin systems is limited and does not establish clinical benefit.
Definitions and Staging
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