What Span-America support surfaces are covered by Medicare for homecare patients?
Can you simplify this for me? How can I tell if a patient qualifies for a certain Span-America mattress?
This is a simplified guide to the Medicare patient criteria to qualify for Group 1 or Group 2 Support Surfaces, and the Span-America products that are approved for each Group.
What is required when I bill Medicare for Support Surfaces?
All claims are submitted on the Claim Form 1500. Claims must be submitted with a KX modifier, indicating that specific required documentation is on file. For support surfaces, that documentation includes an order signed and dated by the treating physician, and a signed and dated statement concerning which criteria listed in the Coverage and Payment Rules sections of the medical policies for Group 1 or Group 2 support surfaces the patient meets. Links to suggested forms that are not required for claims submissions are below.
CMS Statement of Ordering Physician for Group 1 support surfaces
How do I find out what Medicare will pay me?
Fee schedules are updated and released regularly by CMS. Click here for a link to the CMS website for fee schedules and updates.
Can you direct me to information from my Medicare Region on coverage for Support Surfaces?
Support Surface LCD’s (local coverage determinations) including medical review policies are set by the medical directors of all 4 regions. Therefore, LCD's apply to all regions and are housed on the CMS website.
Group 1 Support Surface LCD All Regions
Group 2 Support Surface LCD All Regions
The CMS Website is huge! Where do I go to learn about billing DME?
Centers for Medicare & Medicaid Services (CMS) Durable Medical Equipment (DME) Center is an excellent site for all forms, questions, and links to billing Medicare for DME. Click here to access this site.
Is there a convenient place to learn about Medicare for each individual state?
State-by-state information is available in a map form on the Palmetto GBA website. Click here to access this helpful site.