Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.31
    OpenPayerPolicy UpdatesDurable Medical Equipment (DME)North Dakota HHS Support Surfaces Coverage | OpenP…
    Ask Trek AI about this page
    CurrentNorth Dakota Department of Health & Human ServicesPolicy N/A

    Pressure Reducing Support Surfaces

    Customize your policy alerts

    Sign up for all North Dakota Department of Health & Human Services policy alerts

    Know when North Dakota Department of Health & Human Services releases new policies or updates existing guidance.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    This policy governs Medicaid coverage and service authorization for pressure reducing support surfaces, including powered pressure reducing mattresses and air fluidized beds, when specified immobility, positioning, pressure-ulcer, and medical-necessity criteria are met.

    Policy Summary
    PayerNorth Dakota Department of Health & Human Services
    PolicyPressure Reducing Support Surfaces
    Policy CodePolicy N/A
    Change TypeAdministrative clarificationno material clinical or coverage change
    Effective DateMarch 1, 2007
    Next Review DateN/A
    Key ActionService authorization is required for pressure reducing support surfaces.
    SourceLink
    POLICY UPDATE CHANGES

    July 2017 review and reformatting clarified coding.

    The November 23, 2022 revision changed 60 to 90 in the documentation section.

    The December 23, 2025 revision removed CMN wording from the header and documentation requirements.

    YesService authorization required
    2

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Base coverage conditions
    5Clinical risk factors
    E0277Powered mattress code
    E0194Air fluidized bed code
    III/IVAir fluidized bed ulcer severity

    Coverage Criteria

    General coverage criteria

    Coverage is allowed when all base conditions are met and at least one listed pressure-ulcer or related clinical risk factor is present.

    Base medical-necessity criteria

    • Required conditions

      • The member is completely immobile.
      • The member cannot independently make changes in body position.

    • At least one pressure-ulcer or related clinical risk factor

      • Pressure ulcer on the trunk or pelvis
      • Impaired nutritional status
      • Altered sensory perception
      • Compromised circulatory status
      • Incontinence of bowel or bladder

    Powered pressure reducing mattress

    At least one of the following additional criteria must be met for a powered pressure reducing mattress.

    Powered mattress criteria

    • The mattress overlay has failed.
    • Ulcers have worsened or remained the same over the past month.Over the past month
    • Multiple stage II ulcers are present on the trunk or pelvis.Multiple stage II ulcers; trunk or pelvis

    Air fluidized bed exception

    An air fluidized bed is covered as an exception only when all of the following criteria are met.

    Air fluidized bed exception criteria

    • Without the bed, the member would require institutionalization.
    • The member has a stage III or IV ulcer.Stage III or IV
    • The member is bedridden as a result of severely limited mobility.
    • All other measures have failed.All other measures

    Medical Necessity Requirements

    General pressure reducing support surface

    Medical necessity requires all general support-surface criteria below.

    General support-surface criteria

    • The member is completely immobile.
    • The member cannot independently make changes in body position.

    • At least one pressure-ulcer or related clinical risk factor

      • Pressure ulcer on the trunk or pelvis
      • Impaired nutritional status

    Coding and Clinical Thresholds

    Powered Pressure Reducing MattressHCPCSCovered
    E0277Powered Pressure Reducing Mattress
    Air Fluidized BedHCPCSCovered
    E0194Air Fluidized Bed
    Unchanged or worsened ulcers
    TimeframeOver the past month
    Ulcer statusUlcers have worsened or remained the same
    Applies toPowered Pressure Reducing Mattress (E0277)
    Multiple stage II ulcers
    NumberMultiple ulcers
    Ulcer stageStage II
    Required locationOn the trunk or pelvis

    Authorization and Denial Risks

    Prior Authorization

    Prior Authorization Required

    Service authorization is required before providing or billing pressure reducing support surfaces, including pressure reducing mattresses and air fluidized beds.

    Denial Risk

    Base Coverage Criteria Not Met

    Base coverage may be denied when the member does not meet the required immobility and positioning criteria and does not have a qualifying pressure-ulcer or listed clinical risk factor.

    • Member must be completely immobile.
    • Member must be unable to independently change body position.
    • A pressure ulcer on the trunk or pelvis and/or impaired nutritional status, altered sensory perception, compromised circulatory status, or bowel or bladder incontinence must be present.

    Policy Background

    This policy addresses pressure reducing support surfaces for members who are completely immobile and unable to independently change body position. Coverage consideration is associated with a pressure ulcer on the trunk or pelvis and/or related clinical factors such as impaired nutritional status, altered sensory perception, compromised circulatory status, or bowel or bladder incontinence. Powered mattresses and air fluidized beds have additional criteria, with air fluidized beds covered only as an exception when the specified severity, mobility, institutionalization-risk, and treatment-failure conditions are met.

    Policy Summary
    PayerNorth Dakota Department of Health & Human Services
    PolicyPressure Reducing Support Surfaces
    Policy CodePolicy N/A
    Change TypeAdministrative clarificationno material clinical or coverage change
    Effective DateMarch 1, 2007
    Next Review DateN/A
    Key ActionService authorization is required for pressure reducing support surfaces.
    SourceLink
    On This Page
    Coverage CriteriaMedical Necessity RequirementsCoding and Clinical ThresholdsAuthorization and Denial RisksPolicy Background
    Altered sensory perception
  1. Compromised circulatory status
  2. Incontinence of bowel or bladder

    3. Powered pressure reducing mattress

    For a powered pressure reducing mattress, at least one additional criterion must be met.

    Powered mattress criteria

    • The mattress overlay has failed.
    • Ulcers have worsened or remained the same over the past month.Over the past month
    • Multiple stage II ulcers are present on the trunk or pelvis.Multiple stage II ulcers; trunk or pelvis

    Air fluidized bed

    An air fluidized bed is medically necessary only when all exception criteria are met.

    Air fluidized bed exception criteria

    • Without the bed, the member would require institutionalization.
    • The member has a stage III or IV ulcer.Stage III or IV
    • The member is bedridden as a result of severely limited mobility.
    • All other measures have failed.All other measures
    Air fluidized bed ulcer severity
    Required severityStage III or IV ulcer
    Applies toAir Fluidized Bed (E0194)
    Coverage statusCovered as an exception only
    Denial Risk

    Powered Mattress Criteria Not Met

    Coverage for a powered pressure reducing mattress (E0277) may be denied when the supporting clinical criteria are not documented.

    • The mattress overlay has not failed.
    • Ulcers have not worsened or remained the same over the past month.
    • The member does not have multiple stage II ulcers on the trunk or pelvis.
    Denial Risk

    Air Fluidized Bed Exception Criteria Not Met

    An air fluidized bed (E0194) is covered only as an exception when all required exception criteria are satisfied. Coverage may be denied if any requirement is absent.

    • Without the bed, the member would require institutionalization.
    • The member has a stage III or IV ulcer.
    • The member is bedridden as a result of severely limited mobility.
    • All other measures have failed.