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HealthPartners

Coverage criteria policies

Cushions

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Does not require prior authorization.

Coverage

Generally covered subject to the indications listed below and following limits from your member contract:

Indications that are covered

  1. When prescribed for individuals with paraplegia or quadriplegia for the purpose of relieving pressure and reducing the risk of pressure sores.
  2. For individuals who either suffer from, are at high risk, or have a history of skin breakdown. The purpose of the cushion is to:
    1. Prevent or heal pressure sores
    2. Enhance tissue viability
    3. Enhance positioning
    4. Enhance pressure distribution
    5. Minimize shear & friction
    6. Maximize blood flow
  3. Limit is one cushion.
  4. Replacement cushions will be reviewed on a case by case basis considering the manufacturers warranty and the reasons for replacement.

Indications that are not covered

  1. For comfort and convenience.
  2. An Eggcrate cushion does not provide pressure relief or pressure reduction.
  3. Duplicate or similar items are excluded from coverage. Therefore, multiple cushions are not covered.

Definitions

Cushions serve as an interface device between flat seating surfaces and the complex contours of the human body. An effective cushion is one that enhances a person's capability to function and endure. It should extend sitting times without risking tissue breakdown and should facilitate the healing of damaged tissue. These items should promote tissue viability and positioning. Facilitating tissue viability is the most important function that a cushion can provide for those who have impaired skin integrity, are immobile and/or lack sensation. A cushion which can provide a healing environment inherently prevents tissue breakdown.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy contact Member Services at 952-883-7979 or 1-800-233-9645.

Vendor

  • Items must be received from a contracted vendor for in-network benefits to apply.

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Policy activity

  • 06/01/2000 - Date of origin
  • 06/01/2000 - Effective date
Review date
  • 12/2015

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