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Pressure Reducing Support Surfaces

CMS requires prior authorization of these Group 2 Pressure Reducing Support Surfaces (PRSS) HCPCS codes for all states and territories:

E0193, E0277, E0371, E0372, and E0373.

We will base the prior authorization decision on the Pressure Reducing Support Surfaces - Group 2 Local Coverage Determination (LCD) L33642External Website and related Policy Article A52490External Website.

How to Send Your Request

When to Expect the Decision

We will send a detailed decision letter by the fifth business day.

Expedited requests: If there is a valid need for an expedited review, we will make reasonable efforts to send a decision within two days.

Expedited Reviews

Only request an expedited review if a delay of the prior authorization decision could jeopardize the life or health of the beneficiary.

Patients that have a diagnosis of a myocutaneous flap or skin graft who meet coverage criterion 3 in (LCD) L33642External Website may meet the criteria for an expedited review.

Deliver the Support Surface Within One Month

Prior authorization decisions for support surfaces are valid for one month after the provisional affirmation review decision. If the supplier does not deliver the items within one month of the decision, the supplier will need to send another prior authorization request.

Support Surface Resources

Reasons for Non-Affirmed Prior Authorization for Group 2 Pressure Reducing Support Surfaces

  • The order was missing or incomplete.
  • The documentation has amendments, corrections, and/or delayed entries that do not follow accepted record keeping principles.
  • There is not a valid handwritten or electronic signature by the author of the medical record.
  • Claim history shows same or similar equipment.
  • The documentation did not confirm that the beneficiary met the LCD coverage criteria.

    Note: For coverage criteria 2 (The beneficiary has large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis), this means documenting more than one stage III or IV pressure ulcer on the trunk or pelvis. Medicare will also consider coverage for a single, large pressure ulcer, with "large" traditionally defined as >8 cm2 in size. Medical review clinicians, when considering coverage of large ulcers, take into account whether undermining and/or tunneling are present, the anatomic location on the body and the size of the beneficiary.

To resolve these errors, review the information published in Supplier Manual Chapter 3 – Supplier DocumentationPDF, (LCD) L33642External Website, and Policy Article A52490External Website.

Updated: 06.18.24


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