Bariatric Mattress Selection: 7 Essential Criteria for Pressure Injury Prevention & Medicare Reimbursement

Why Are Bariatric Patients at Higher Risk for Pressure Injuries?

For healthcare providers, the challenge of preventing pressure injuries in bariatric patients is significant, not only for patient well-being but also for operational efficiency and financial sustainability. Bariatric patients are clinically recognized to be at increased risk of pressure injuries. Research indicates that up to 26% develop pressure ulcers, and individuals with severe obesity may face a threefold increase in risk^1,2. This multifactorial vulnerability involves compromised perfusion, mechanical pressure, impaired mobility, and skin challenges that reduce the body’s ability to tolerate sustained loading.

Skin Structure and Perfusion Challenges

Excess adipose tissue and uneven body mass distribution impair capillary perfusion and increase sustained pressure over bony prominences such as the sacrum, scapulae, and heels. Compromised vascular flow makes these patients more prone to deep tissue injury.³

Difficulty with Repositioning and Increased Friction 

Reduced mobility makes independent repositioning difficult, increasing reliance on caregivers. This elevates the likelihood of prolonged pressure exposure and adds mechanical forces like shear and friction during transfers. In many cases, patients may also be unable to reposition effectively due to mattress size limitations, particularly when standard-width surfaces do not accommodate body contours or limb movement.³

Common Comorbidities and Delayed Healing Factors

Conditions such as diabetes, cardiovascular disease, and excess moisture from perspiration can impair skin integrity and delay wound healing, making injury prevention more complex^3,4.

Risk Stratification and Clinical Care Challenges 

Assessing Risk with the Braden Scale

The Braden Scale remains one of the most commonly used tools for assessing pressure injury risk. Bariatric patients often score in the lower ranges, indicating a high need for preventative care³.

Caregiver Burden and Repositioning Demands

Repositioning bariatric patients often requires multiple caregivers, increasing the risk of musculoskeletal injuries and operational strain^3,4.  A 15% higher risk of pressure ulcers has been reported among individuals with higher body weight, especially in facilities with limited staff support⁶, where preventive care for bariatric patients is often difficult to implement due to inappropriate or inadequate resources⁷.

Shear and Friction During Transfers

Transfers often involve resistance between the skin and support surface, contributing to mechanical damage through shear and friction forces.³

7 Key Features to Look for in a Bariatric Mattress

Choosing the right pressure-relieving mattress for bariatric patients is essential for reducing the risk of pressure injuries, maintaining clinical care standards, and complying with reimbursement criteria. Below is a streamlined set of 7 key features clinicians and equipment providers should prioritize when evaluating bariatric support surfaces:

Clinical Benefits of Alternating Pressure Systems

1.  Eligibility and Medicare Qualification: To qualify for Medicare Part B (HCPCS E0277) reimbursement, the patient must have a documented Stage II or higher pressure injury, show failure on standard support surfaces, and require home-based care. A physician’s prescription and medical necessity documentation are required.⁵

2. E0277 Functional Criteria (Alternating or Low Air Loss): To be eligible under E0277, the surface must provide either alternating pressure or low air loss therapy. These features are essential for reducing sustained pressure and maintaining skin microclimate, especially in areas like skin folds.^3,5

3. Weight Support and Structural Reinforcement: The mattress must provide adequate lift for heavier patients using air cells at least 5 inches tall. This prevents “bottoming out”, a critical factor in pressure injury development for heavier individuals. While many models support 500 lbs or more, Medicare focuses on clinical performance, rather than a fixed weight rating. A reinforced base and hospital bed compatibility are also essential. ⁵

4. Low Pressure or Static Mode: For patients with open wounds or highly fragile skin, a static or continuous low-pressure setting can enhance comfort and healing by maintaining consistent immersion and envelopment. ³ This is crucial for preventing further damage and promoting healing in areas already compromised by wounds.

5. Seat Inflation Mode: Dedicated seat inflation zones provide enhanced support when the patient is in a semi-upright or seated position, minimizing the risk of sacral collapse or bottoming out during daily activities like eating or breathing treatments.^3,4
6. Shear and Friction Reduction: Mattresses should feature low-friction, stretchable fabrics combined with dynamic pressure cycles to help reduce shear, which is a major contributor to deep tissue injury.

7. Practical Considerations for Long-Term Use : Other important factors include mattress width, ease of cleaning, overall durability, and compatibility with lifts or repositioning systems. These details support safe and efficient use in real-world care settings. ^3,5  

An appropriate bariatric support surface not only prevents new pressure injuries but also contributes to patient dignity, comfort, and safety while reducing physical strain on caregivers and improving workflow efficiency. ^3,4

Frequently Asked Questions (FAQ) 

What is HCPCS E0277 for mattresses?

HCPCS E0277 refers to a Medicare billing code for powered pressure-reducing mattresses used in home care. These support surfaces must include either alternating pressure or low air loss therapy and meet specific technical and clinical criteria, such as providing at least 5 inches of lift and reducing shear and friction. They are typically prescribed for patients with Stage II or higher pressure injuries who have not responded to standard mattresses.⁵

How does a low air loss mattress work for bariatric patients?

Low air loss mattresses use a system of air flow through small holes in air cells to manage heat and moisture buildup. For bariatric patients, this is particularly important for preventing maceration and pressure injuries in skin folds. These systems also help maintain skin integrity by keeping the surface dry and thermally stable. ^3,5

Is a bariatric mattress covered by Medicare?

Yes, bariatric mattresses may be covered under Medicare Part B if they meet the HCPCS E0277 criteria and the patient meets the clinical eligibility requirements. A physician’s prescription and medical necessity documentation are required.⁵

Explore the Impact of Pressure Injuries on Your Hospital

"Wellell Pro-care Auto Bariatric support surfaces"  

 Advanced Support Surfaces for Bariatric Pressure Injury Prevention

Here are the key benefits it provide:

1.  Simplified care workflow: The automatic pressure adjustment feature reduces the need for manual settings, helping nurses save time and physical effort during routine care.

2. Wider and sturdier surface for safe repositioning:  A spacious, reinforced mattress provides patients with more room to move and facilitates safe repositioning or turning.

3. Full compliance with E0277 standards: Delivers a complete set of clinically proven functions, including alternating pressure or low air loss therapy, continuous low pressure mode, seat inflation mode, and shear and friction reduction. These features are specifically designed to meet the complex needs of bariatric patients.

Figure1：Special air cell design and settings ensure that bariatric patients do not bottom out while seated.

Procare Bariatric G2 Pro-care Auto Bariatric - Support Surfaces - Pressure Area Care | Wellell