Local Coverage Determination · DME MAC
L33830
Pressure Reducing Support Surfaces - Group 1
Version 22. CMS effective date 05/01/2021. CMS updated 03/12/2021. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
CMS coverage policy citation. CMS Pub. 100-03, (Medicare National Coverage Determinations Manual), Chapter 1, Section 280.1
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. A Group 1 mattress overlay or mattress ( E0181, E0182, E0184, E0185, E0186, E0187, E0188, E0189, E0196, E0197, E0198, E0199 and A4640) is covered if one of the following three criteria are met: The beneficiary is completely immobile - i.e., beneficiary cannot make changes in body position without assistance, or The beneficiary has limited mobility - i.e., beneficiary cannot independently make changes in body position significant enough to alleviate pressure and at least one of conditions A-D below, or The beneficiary has any stage pressure ulcer on the trunk or pelvis and at least one of conditions A-D below.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met prior to Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
- A52489 · Pressure Reducing Support Surfaces - Group 1 - Policy Article
Related NCDs
- NCD 280.1 · Durable Medical Equipment Reference List (version 4)
HCPCS codes on this LCD
2 other Level II codes are on the LCD and are not given a page in this set: A4640, E1399.
Questions
What does LCD L33830 cover?
L33830 is Pressure Reducing Support Surfaces - Group 1. It is a current final DME MAC local coverage determination, version 22.
Where is the CMS source for L33830?
The Medicare Coverage Database page for LCD L33830 version 22.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=A9270&as_of=2024-01-15&npi=1234567890&state=UT"