Support Surface Reimbursement for Homecare

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.

 

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.

 

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.