CMS Pub. 100-03, ch. 1, § 280.8

CIM 60-19

Air fluidized beds are covered for services rendered on or after: July 30, 1990.

An air-fluidized bed uses warm air under pressure to set small ceramic beads in motion which

simulate the movement of fluid. When the patient is placed in the bed, his body weight is evenly

distributed over a large surface area which creates a sensation of “floating.” Medicare payment

for home use of the air-fluidized bed for treatment of pressure sores can be made if such use is

reasonable and necessary for the individual patient.

A decision that use of an air-fluidized bed is reasonable and necessary requires that:

• The patient has a stage 3 (full thickness tissue loss) or stage 4 (deep tissue destruction)

pressure sore;

• The patient is bedridden or chair bound as a result of severely limited mobility;

• In the absence of an air-fluidized bed, the patient would require institutionalization;

• The air-fluidized bed is ordered in writing by the patient’s attending physician based

upon a comprehensive assessment and evaluation of the patient after completion of a course of

conservative treatment designed to optimize conditions that promote wound healing. This course

of treatment must have been at least one month in duration without progression toward wound

healing. This month of prerequisite conservative treatment may include some period in an

institution as long as there is documentation available to verify that the necessary conservative

treatment has been rendered.

• Use of wet-to-dry dressings for wound debridement, begun during the period of

conservative treatment and which continue beyond 30 days, will not preclude coverage of air-fluidized bed. Should additional debridement again become necessary, while a patient is using

an air-fluidized bed (after the first 30-day course of conservative treatment) that will not cause

the air-fluidized bed to become noncovered. In all instances documentation verifying the

continued need for the bed must be available.

• A trained adult caregiver is available to assist the patient with activities of daily living,

fluid balance, dry skin care, repositioning, recognition and management of altered mental status,

dietary needs, prescribed treatments, and management and support of the air-fluidized bed

system and its problems such as leakage;

• A physician directs the home treatment regimen, and reevaluates and recertifies the need

for the air-fluidized bed on a monthly basis; and

• All other alternative equipment has been considered and ruled out.

Conservative treatment must include:

• Frequent repositioning of the patient with particular attention to relief of pressure over

bony prominences (usually every 2 hours);

• Use of a specialized support surface (Group II) designed to reduce pressure and shear

forces on healing ulcers and to prevent new ulcer formation;

• Necessary treatment to resolve any wound infection;

• Optimization of nutrition status to promote wound healing;

• Debridement by any means (including wet to dry dressings-which does not require an

occlusive covering) to remove devitalized tissue from the wound bed;

• Maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings

protected by an occlusive covering, while the wound heals.

Home use of the air-fluidized bed is not covered under any of the following circumstances:

• The patient has coexisting pulmonary disease (the lack of firm back support makes

coughing ineffective and dry air inhalation thickens pulmonary secretions);

• The patient requires treatment with wet soaks or moist wound dressings that are not

protected with an impervious covering such as plastic wrap or other occlusive material;

• The caregiver is unwilling or unable to provide the type of care required by the patient on

an air-fluidized bed;

• Structural support is inadequate to support the weight of the air-fluidized bed system (it

generally weighs 1600 pounds or more);

• Electrical system is insufficient for the anticipated increase in energy consumption; or

• Other known contraindications exist.

Coverage of an air-fluidized bed is limited to the equipment itself. Payment for this covered

item may only be made if the written order from the attending physician is furnished to the

supplier prior to the delivery of the equipment. Payment is not included for the caregiver or for

architectural adjustments such as electrical or structural improvement.

Cross reference:

The Medicare Claims Processing Manual, Chapter 23, “Fee Schedule Administration and Coding

Requirements,” §§60.