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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that Medicare payment for home use of the air-fluidized bed for treatment of pressure sores can 
be made if such use is reasonable and necessary for the individual patient. A decision that use of an air-
fluidized bed is reasonable and necessary requires that: 
 
1. The patient has a stage 3 (full thickness tissue loss) or stage 4 (deep tissue destruction) pressure sore; 
2. The patient is bedridden or chair bound as a result of severely limited mobility; 
3. In the absence of an air-fluidized bed, the patient would require institutionalization; 
4. The air-fluidized bed is ordered in writing by the patient's attending physician based upon a comprehensive 
assessment and evaluation of the patient after completion of a course of conservative treatment designed to 
optimize conditions that promote wound healing. This course of treatment must have been at least one month in 
duration without progression toward wound healing. This month of prerequisite conservative treatment may 
include some period in an institution as long as there is documentation available to verify that the necessary 
conservative treatment has been rendered. 
5. Use of wet-to-dry dressings for wound debridement, begun during the period of conservative treatment and 
which continue beyond 30 days, will not preclude coverage of air-fluidized bed. Should additional debridement 
again become necessary, while a patient is using an air-fluidized bed (after the first 30-day course of 
conservative treatment) that will not cause the air-fluidized bed to become non-covered. In all instances 
documentation verifying the continued need for the bed must be available. 
6. A trained adult caregiver is 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; 
7. A physician directs the home treatment regimen, and reevaluates and recertifies the need for the air-fluidized 
bed on a monthly basis; and 
8. All other alternative equipment has been considered and ruled out. 
 
You can find this rule in the National Coverage Determination (NCD) - Air-Fluidized Bed (280.8) - Effective 
November 1, 2000. 
 
The rules say that conservative treatment must include:  
1. Frequent repositioning of the patient with particular attention to relief of pressure over bony prominences 
(usually every 2 hours); 
2. Use of a specialized support surface (Group II) designed to reduce pressure and shear forces on healing 
ulcers and to prevent new ulcer formation; 
3. Necessary treatment to resolve any wound infection; 
4. Optimization of nutrition status to promote wound healing; 
5. Debridement by any means (including wet to dry dressings-which does not require an occulsive covering) to 
remove devitalized tissue from the wound bed; 
6. Maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings protected by an 
occlusive covering, while the wound heals. 
 
You can find this rule in the National Coverage Determination (NCD) - Air-Fluidized Bed (280.8) - Effective 
November 1, 2000. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.