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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 state that an air-fluidized bed is covered only if all of the following criteria are met: 
1. The beneficiary has a stage 3 (full thickness tissue loss) or stage 4 (deep tissue destruction) pressure 
ulcer (Refer to the ICD-10 codes in the LCD-related Policy Article for applicable diagnoses). 
2. The beneficiary is bedridden or chair bound as a result of severely limited mobility. 
3. In the absence of an air-fluidized bed, the beneficiary would require institutionalization. 
4. The air-fluidized bed is ordered in writing by the beneficiarys treating practitioner based upon a 
comprehensive assessment and evaluation of the beneficiary after completion of a course of 
conservative treatment designed to optimize conditions that promote wound healing. The evaluation 
generally must be performed within one month prior to initiation of therapy with the air-fluidized bed. 
5. The course of conservative 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 was rendered. Conservative treatment must include: 
a. Frequent repositioning of the beneficiary with particular attention to relief of pressure over bony 
prominences (usually every 2 hours); and 
b. Use of a Group 2 support surface to reduce pressure and shear forces on healing ulcers and to 
prevent new ulcer formation; and 
c. Necessary treatment to resolve any wound infection; and 
d. Optimization of nutrition status to promote wound healing; and 
e. Debridement by any means, including wet-to-dry gauze dressings, to remove devitalized tissue 
from the wound bed; and 
f. Maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings 
protected by an occlusive covering, while the wound heals. 
An air-fluidized bed will be denied as not reasonable and necessary under any of the following circumstances: 
1. The beneficiary has coexisting pulmonary disease (the lack of firm back support makes coughing 
ineffective and dry air inhalation thickens pulmonary secretions); 
2. The beneficiary requires treatment with wet soaks or moist wound dressings that are not protected with 
an impervious covering such as plastic wrap or other occlusive material; 3. The caregiver is unwilling or unable to provide the type of care required by the beneficiary on an air-
fluidized bed; 
4. Structural support is inadequate to support the weight of the air-fluidized bed system (it generally 
weighs 1600 pounds or more); 
5. Electrical system is insufficient for the anticipated increase in energy consumption; or 
6. Other known contraindications exist. 
You can find these rules in the Local Coverage Determination (LCD), L33692. 
 
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.