Group 1 Support Surfaces - Product Classification
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1 Group 1 Support Surfaces - Product Classification The following product classification list identifies the correct HCPCS code to be used for pressure reducing support surfaces - group 1. This list is not all-inclusive. Questions concerning the coding of items not on this list should be directed to the SADMERC. For support surfaces not on the list, suppliers should use their knowledge of the product and the information in the medical policy to determine the correct code until a determination is published in a future update or they receive a response from the SADMERC to a coding inquiry. See the Definitions and Coding Guidelines sections of the policy for additional important coding information. The appearance of a product on this list does not guarantee coverage. This list is not a formal part of the medical policy. MANUFACTURER; PRODUCT NAME; HCPCS CODE: ACS ACS Comfort Gel Plus Mattress Pad E0185 ACS ACS Gel Foam Overlay E1399 Action Medical Action Full Mattress Pad # E0185 Action Medical Action Professional Mattress Pad# 6300 E0185 Action Medical Action Shear Reduction Pad #6304 E1399 Action Medical Action Professional #6100/6200 E1399 Air Med Assist Products Nurses Aid Mattress Pad E0197 Anatomic Concepts Anatomical Mattress Pad with Heel-Ease E0199 Anatomic Concepts Comfort ET Specialty Mattress E0184 Anatomic Concepts Comfort Infection Control Mattress E0184 Anatomic Concepts Comfort Pressure Relief Mattress E0184 Anatomic Concepts Conforma I or II Mattress Pad E0199 Anatomic Concepts Conforma I or II Replacement Mattress E0184 Anatomic Concepts Critical Care with Heel-Ease Mattress E0184 Atlantis Medical ISIS Mattress E1399 Atlantis Medical Self Adjusting Mattress (SAM) E0186 Atlantis Medical Tri-Zone Mattress Pad E0199 Atlantis Medical Zaam Mattress E0186
2 Bergad Mattress Isotonic Pressure Reduction Mattress E0184 Best Care Corporation Excel 1000 Mattress Pad E0180 Best Care Corporation Excel 2000 Mattress Pad E0180 BG Industries AccuMax Mattress E0186 BG Industries AccuMax PC Mattress E0186 BG Industries AccuMax Residential Mattress E0186 BG Industries Five Zone System Mattress Pad with cover E0199 BG Industries Five Zone System Mattress Pad without cover A9270 BG Industries GelMax Therapeutic Mattress Pad E0199 BG Industries MaxiFloat Rx Pressure Reduction Mattress E0184 BG Industries Seven Zone System Mattress Pad with cover E0199 BG Industries Seven Zone System Mattress Pad without cover A9270 Bioclinic Biotherapy Advanced Pressure Relief System Mattress Pad E0180 BioCompression Sys. Biocomfort Gel Foam Mattress Pad E0199 BioCompression Sys. Biocomfort Gel Mattress Pad E0185 BioCompression Sys. BioCompression Low Air Loss Pressure Mattress Pad E0180 BioCompression Sys. BioCompression Standard Double Mattress Pad with E0180 Airloss BioCompression Sys. BioCompression Standard Double Mattress Pad without E0180 Airloss BioCompression Sys. BioCompression Standard Pressure Mattress Pad E0180 BioCompression Sys. Gel Foam Mattress Pad E0199 Blue Chip Medical Air-Pro Elite Mattress Pad E0180 Blue Chip Medical Air-Pro Plus Mattress Pad E0180 Blue Chip Medical Stat-Air Mattress Pad E0197 Blue Chip Medical Stat-Gel Mattress Pad E0185 Blue Chip Medical Stat-H2O Mattress Pad E0198 Brewer Medical Advantage Gel Foam Overlay 1000 E1399 Brewer Medical Advantage Gel Foam Overlay 2000 E1399 Brewer Medical Advantage Gel Foam Overlay 3000 E1399 Cardio Systems Pneu-Air Mattress Pad E0181 Cardio Systems Pro-Turn Mattress Pad E0181 CEO, Inc. Prone-Techtor 3.5 Mattress Pad E0199 Chattanooga Group Gel Medex Mattress Pad E0199 Clearview Healthcare DSPD-1 Mattress with RCP202 Pump E1399
3 Clearview Healthcare SAPD4004 Mattress Pad with RCP202 Pump E0180 Comfort Plus, Inc. Synergy Gel Mattress Pad E0185 Comfortex De Cube Therapeutic Mattress E0184 Compression Sys. GelRestx 3" Mattress Pad E0199 Compression Sys. GelRestxII Gel Mattress Pad E0199 Crown Therapeutics Prodigy System Mattress Pad E0197 Crown Therapeutics Sofflex Mattress Pad E0197 DEKA Medical Gel Lite II Mattress Pad E0199 DEKA Medical Gel Lite III Mattress Pad E0185 Derma Safe Systems DermaSafe Decubitus Care Mattress E0184 Derma Safe Systems DermaSafe HealthCare Mattress E0184 Derma Safe Systems DermaSafe Intensive Care Topper Mattress Pad E0199 Dermal Mgmt. Sys. Aero-Pulse Deluxe Mattress Pad E0180 Duro-Med Industries Duro - Matic APP & Pump Mattress Pad E0180 ECP Distributors Carital Air Floatation System Mattress E0186 EHOB Waffle Expansion Control Mattress Pad E0197 Family Medical Gel Flotation Mattress E0184 Flo Care Flo Care Pressure Relief Mattress E0187 Gate City Bed Decubi Care Mattress E0184 Gaymar APP2112 Alternating Pressure System Mattress Pad E0180 Gaymar Heelcare Cushion E1399 Gaymar ISOFLEX Mattress E0184 Gaymar Pillo-Pump APS Mattress Pad E0181 Gaymar Sof-Care Plus Companion System Mattress Pad E0197 Gaymar Top Guard II Mattress E0184 Gaymar Top Guard II Plus Mattress E0184 Gaymar TopGard 1000 Mattress E0184 Gaymar TopGard 2000 Mattress E0184 Gaymar TopGard 3000 Mattress E0184 Genadyne GenAir 3000 Mini Pump and Mattress Pad E0180 Genadyne GenAir 5000 Deluxe Pump and Mattress Pad E0180
4 Genadyne GenGel 3500 Mattress Pad E0185 Golden Technologies Luxury Adjustable Bed A9270 Grant Dyna Soft System Mattress Pad E0180 Homecare Solutions Prevent-A-Care Mattress Pad E0180 Hudson Industries Gel Core Mattress Pad E0199 Hudson Industries Pressure Eez Gel Mattress Pad E0185 Hudson Industries Ultra Gel Mat Mattress Pad E0199 Hudson Industries Ulti-Mat II Mattress Pad E0199 Huntleigh Healthcare Universal Foam Base (AAX-80-BASE) A9270 Huntleigh Healthcare Air-O-Pad (AOP1) with Pump E1399 Huntleigh Healthcare Bubble Pad (OPB2, OPB2FF) with Pump Mattress Pad E0180 Huntleigh Healthcare Double Bubble Pad with Pump Mattress Pad E0180 Huntleigh Healthcare Formation Mattress Pad E0185 Huntleigh Healthcare Formation II Mattress Pad E0199 Huntleigh Healthcare Super Life Bubble Pad (OPB3) with Pump Mattress Pad E0181 Huntleigh Healthcare Ultra Med Alpha X Cell Mattress Pad E0180 Invacare CareGuard 101 Home Care Mattress E0184 Invacare CareGuard APP Mattress Pad E0180 Invacare CareGuard SA Static Air Mattress Pad E0197 KAP Industries Gel-Lite Mattress Overlay E1399 KCI AirKair Mattress Mattress Pad E0197 KCI TheraRest HR Mattress E0184 Ken McRight Supplies Bye-Bye Decubiti Pneumatic Mattress Pad E0197 Lotus GLX 3666 E1399 Lotus Lotus Air 3780 Mattress Pad E0197 Lotus Lotus Air 3787 Mattress Pad E0197 Lotus Lotus DU 4072 Mattress Pad E0197 Lotus Lotus GL 3666 Mattress Pad E0185 Lotus Lotus GLPX 3666 Mattress Pad E0185 Lotus Lotus HM 3666 Mattress Pad E0198 Lotus Lotus HMX Mattress Pad E0198 Lotus Lotus MD 3677 Mattress Pad E0198 Lotus Lotus MDGL 3677 Mattress Pad E0185 Lotus Lotus PXM 3666 Mattress Pad E0198 Lumex Comfort Spectrum 317 Mattress E0184
5 Mason Medical Air-O-Ease Mattress Pad E0197 Mason Medical Gel-U-Sleep 3" Mattress Pad E0185 Mason Medical Gel-U-Sleep 5" Mattress E0184 Mason Medical Hydro-Ease I Mattress Pad E0198 Mason Medical Hydro-Ease II Mattress Pad E0185 Mason Medical Laser I Powered Mattress Pad E0180 Mason Medical Series II and III AP Pump and Mattress Pad E0180 Mason Medical Sierra 3" Mattress Pad E0185 Mason Medical Sierra 5" Mattress E0184 Mason Medical Sierra III Gel Mattress Pad E0199 Mason Medical Unitek Tri-Laminate Mattress E0184 Mason Medical Vari-Zone II Mattress Pad E0199 Mastex Industries Gel-eeze Mattress Pad E0185 Mediq FST FlairCair Plus Mattress E0196 Mellen Air Gel-Mat Mattress Pad E0199 OBUSFORME ComfortFoam A9270 OBUSFORME UltraFoam A9270 OBUSFORME UltraFoam Ventilated Pad A9270 Plexus Medical Plexus P100 Mattress Pad with Pump E0180 PreMed Inc. Pressure Cradle Mattress E0186 ProBed Medical Foamatt Mattress E0184 ProBed Medical Freedom Bed A9270 ProBed Medical Overgel Mattress Pad E0199 Royal Medical Royal Medical Mattress Pad E0199 Southern Foam Viscogel Mattress Pad #6499 E0199 Span-America PressureGuard CFT Mattress E0186 Span-America PressureGuard Custom Care Mattress E0186 Span-America PressureGuard I Mattress E0184 Span-America PressureGuard II Mattress E0186 Span-America PressureGuard Renew Mattress E0186 Span-America PressureGuard Select Mattress E0186 Spann-America Gel T Mattress Pad E0199 Spann-America Geo Matt Mattress Pad E0199 Spann-America Geo Mattress HC E0184 Spann-America Span + Guard Pressure Reducing Mattress Pad E0199
6 Spenco Spenco Bed Mattress Pad E0199 Sports Med 3" Gel/Foam Mattress Pad #MD30352 E0199 Sports Med 3" Gel/Foam Mattress Pad # MD70778 E0185 Sports Med 6" Gel/Foam Mattress E0184 Sports Med Comfort Zone One Mattress Pad E0199 Sports Med Pressure-Ease Foam Mattress E0184 Sunflower Medical Sapphire Series 150 Mattress Pad E0180 Sunflower Medical Sapphire Series 150A Mattress Pad E0180 Sunrise Medical Bio Flote Air Floatation System Mattress Pad E0180 Talley BASE Bellows Flotation/Double Mattress E0186 Talley BASE Bellows Flotation/Single Mattress Pad E0197 Talley Pulsair Large Cell 100 Mattress Pad E0180 Talley Pulsair LX Pump E0182 Talley Pulsair Mattress Pad (Replacement Pad) A4640 Talley Pulsair Ripple Bed Mattress Pad E0180 Talley Sof Form Trizone Mattress Pad E0197 Tele-Made Disposables Comfort Zone Gel Mattress Pad #CM-100 #CM-200 E0199 Tempest International Supra Gel Mattress Pad E0185 Tempest International Supra II Mattress Pad E0198 Tempest International Synergy II Mattress Pad E0198 Tempur-Pedic Tempur-Med Mattress E0184 Tempur-Pedic Tempur-Med Mattress Pad E0199 Tuffcare GT100 Gel Mattress Pad E0185 Turnsoft Air Soft Antidecubitus Mattress E0184 Turnsoft Turnsoft System E1399 Ultimex Corporation Ultimex Gel/Foam Mattress Pad E0199 Ultra Float, Inc. Ultra Float Mattress E0187 Zephyr Therapeutics Flexcell Mattress E0186 Zephyr Therapeutics Gel Cell Plus Mattress Pad E0185 Zephyr Therapeutics Z-Gel Mattress Pad E0199 Revised 4/2000
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Manufacturer Product Name Model Number HCPCS Effective End Date Comments
Your search for Classification: Support Surfaces Manufacturer: Product name: Model number: HCPCS Code: Returned 1416 results *This list reflects only those products reviewed and classified by Noridian.
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