CAM 10101

Air Fluidized Beds

Category:Durable Medical Equipment   Last Reviewed:December 2020
Department(s):Medical Affairs   Next Review:December 2999
Original Date:December 1995    

Description:
An air fluidized bed is a device employing the circulation of filtered air through ceramic spherules (small, round ceramic objects) that is marketed to treat or prevent bedsores or to treat extensive burns.

An air fluidized bed uses warm air under pressure to set small ceramic beads in motion, which simulate a fluid movement. When the patient is placed in the bed, his/her body weight is evenly distributed over a large surface area, which creates a sensation of floating.

Policy:
Use of the air fluidized bed is considered MEDICALLY NECESSARY when ALL of the following indications are met for patients who:

  • Are bedridden and are unable to fully or partially ambulate.
  • Have a stage 3 (full-thickness tissue loss) or stage 4 (deep tissue destruction) pressure sore.
  • Have exhausted conservative treatment without improvement.
  • In the absence of an air fluidized bed, the patient would require institutionalization.
  • Have a trained adult caregiver 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.
  • Have a physician who directs the home treatment regimen and re-evaluates and recertifies the need for the air fluidized bed on a monthly basis.
  • Have utilized and ruled out all other alternative equipment. Such alternatives include, but are not limited to, gel flotation pads, egg crate mattresses and pressure pads and pumps.

Home use of the air fluidized bed is NOT MEDICALLY NECESSARY under ANY of the following circumstances:

  • The patient requires treatment with wet soaks or has moist wound dressings that are not protected with an impervious covering such as plastic wrap.
  • The caregiver is 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 system (it weighs 1,600 pounds or more).
  • The home electrical system is insufficient for the anticipated increase in energy consumption.

References:

  1. Hayes, Inc., The Health Technology Assessment Company. Negative Pressure Wound Therapy for Wound Healing. Published: July 28, 2003.
  2. National Institute for Clinical Excellence (NICE). The prevention and treatment of pressure ulcers. Clinical Guideline No. 29. London, UK: NICE; 2005.
  3. Nixon J, Nelson E A, Cranny G, et al.; PRESSURE Trial Group. Pressure relieving support surfaces: A randomised evaluation. Health Technol Assess. 2006;10(22):1-180.
  4. Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: A systematic review. JAMA. 2006;296(8):974-984.

Coding Section

Codes Number Description
CPT No Code   
ICD-9 Procedure No Code  
ICD-9 Diagnosis 707.0 Decubitus ulcer, any site
  707.0 and 785.4 Decubitus ulcer, any site with gangrene
  707.1 Chronic ulcer, lower limb
  707.8 Chronic ulcer, other specified sites
  707.9 Chronic ulcer, unspecified sites
HCPCS E0194 Air fluidized beds
ICD-10-CM (effective 10/01/15)  L8990 Pressure ulcer of unspecified site, unspecified stage 
  L89009  Pressure ulcer of unspecified elbow, unspecified stage 
  L89119  Pressure ulcer of right upper back, unspecified stage 
  L89129  Pressure ulcer of left upper back, unspecified stage 
  L89139  Pressure ulcer of right lower back, unspecified stage 
  L89149  Pressure ulcer of left lower back, unspecified stage 
  L89159  Pressure ulcer of sacral region, unspecified stage 
  L89209  Pressure ulcer of unspecified hip, unspecified stage 
  L89309  Pressure ulcer of unspecified buttock, unspecified stage 
  L89509  Pressure ulcer of unspecified ankle, unspecified stage 
  L89609  Pressure ulcer of unspecified heel, unspecified stage 
  L89819  Pressure ulcer of head, unspecified stage 
  L89899  Pressure ulcer of other site, unspecified stage 
  L97909  Non-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity 
  L97109  Non-pressure chronic ulcer of unspecified thigh with unspecified severity 
  L97209  Non-pressure chronic ulcer of unspecified calf with unspecified severity 
  L97309  Non-pressure chronic ulcer of unspecified ankle with unspecified severity 
  L97409  Non-pressure chronic ulcer of unspecified heel and midfoot with unspecified severity 
  L97509  Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity 
  L97809  Non-pressure chronic ulcer of other part of unspecified lower leg with unspecified severity 
  L98419  Non-pressure chronic ulcer of buttock with unspecified severity 
  L98429  Non-pressure chronic ulcer of back with unspecified severity 
  L98499  Non-pressure chronic ulcer of skin of other sites with unspecified severity 
  and   I96 Gangrene, not elsewhere classified 
ICD-10-PCS (effective 10/01/15)   

ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this therapy.

Type of Service DME  
Place of Service Inpatient, Home  

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

Index
Air Fluidized Beds
Beds, Air Fluidized
Clinitron Beds

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2013 Forward     

12/17/2020 

Annual review, no change to policy intent. 

12/21/2018 

Annual review, no change to policy intent. 

12/20/2017 

Annual review, no change to policy intent. 

12/29/2016 

Annual review, no change to policy intent. 

09/22/2015 

Added ICD-10 coding to policy. 

12/01/2014 

Annual review. Added coding and Index. No change to policy intent. 

12/02/2013

Annual Review. No changes made.

 


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