Air Fluidized Beds - CAM 10101

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:

Hayes, Inc., The Health Technology Assessment Company. Negative Pressure Wound Therapy for Wound Healing. Published: July 28, 2003.
National Institute for Clinical Excellence (NICE). The prevention and treatment of pressure ulcers. Clinical Guideline No. 29. London, UK: NICE; 2005.
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.
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, and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

History From 2013 Forward

12/11/2024	Annual review, no change to policy intent.
12/04/2023	Annual review, no change to policy intent.
12/21/2022	Annual review, no change to policy intent.
12/08/2021	Annual review, no change to policy intent
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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Air Fluidized Beds - CAM 10101