In summary
| 📋 Section | Description |
|---|---|
| 🔎 Introduction | LLPP mattresses play a crucial role in preventing or relieving pressure sores. Their reimbursement reduces costs for patients in a dependent situation. |
| 🛏️ What is an LLPP mattress? | A medical device designed to prevent pressure sores, prescribed in cases of prolonged immobility. |
| ✔️ Eligibility criteria | The mattress must be listed on the LLPP, prescribed by a doctor, and meet specific medical indications such as an assessed risk on the Norton scale. |
| 💰 Reimbursement rate | The rates vary depending on the type of mattress, generally 60% covered by Health Insurance, with possible supplements from a mutual insurance. |
| 📊 Model comparison | Comparison between viscoelastic, air, and polyurethane foam mattresses in terms of cost, benefits, and recommended use. |
| 🔄 Other reimbursed equipment | List of reimbursed medical devices, such as wheelchairs, walkers, or anti-pressure sore cushions, with their reimbursement bases. |
| 📝 Procedures for reimbursement | Steps to obtain reimbursement: medical prescription, invoice, CERFA form to be sent to CPAM. |
| 📌 Special cases | Enhanced reimbursements for patients with ALD, disabilities, or severe pathologies. |
| 💡 Importance of the mutual insurance | A mutual insurance can supplement remaining costs, covering up to 40% or more of the expense. |
| 🛠️ How to choose a mattress? | Criteria to consider: patient’s weight, duration of immobility, risk of pressure sores, and medical recommendations. |
| 👩⚕️ Role of health professionals | Doctors, nurses, and authorized providers assist patients in choosing, prescribing, and installing mattresses. |
| ❓ Frequently Asked Questions | FAQs about coverage conditions, validity period, the difference between renting and purchasing, and included costs. |
| 📝 Conclusion | The reimbursement of an LLPP mattress is essential to reduce dependency-related costs but requires meeting eligibility criteria. |
The LLPP mattresses (List of Covered Products and Services) play a crucial role for individuals with specific medical needs, especially those facing pressure sore problems or pain linked to prolonged immobility. Their reimbursement by social security significantly reduces the financial burden for patients and their families. In this article, we explain in detail the reimbursement rates, eligibility conditions, and necessary procedures to benefit from this support.
What is an LLPP mattress and why is it reimbursed?
An LLPP mattress (List of Covered Products and Services) is designed to meet specific medical needs, particularly to prevent or relieve pressure sores. These medical devices are prescribed by a doctor in situations where the patient must remain bedridden for extended periods.
Criteria for eligibility for reimbursement
For a mattress to be covered by social security, it must:
- Be listed on the List of Products and Services.
- Meet specific medical indications such as a pressure sore risk assessed on the Norton scale.
- Be prescribed by a specialist doctor.
| Required criteria | Details |
|---|---|
| Listing on the LLPP | Yes |
| Medical prescription | Mandatory |
| Risk assessment | Score ≤ 14 on the Norton scale or equivalent |
What are the reimbursement rates for LLPP mattresses?
The reimbursement rate depends on the type of mattress and eligibility conditions. Generally, Health Insurance covers 60% of the base price, and a mutual insurance can cover the difference.
| Type of mattress | Base price (€) | Health Insurance Reimbursement (€) | Reimbursement rate (%) |
|---|---|---|---|
| Viscoelastic mattress (Class II) | 296.62 | 177.97 | 60% |
| Polyurethane foam mattress (Class IA) | 135.45 | 81.27 | 60% |
Example of reimbursement
For a mattress costing €296.62, Health Insurance reimburses €177.97. The remaining amount can be covered by a supplementary mutual insurance.
Comparison of different mattress models
This table helps compare the main features of various types of LLPP mattresses:
| Model | Type | Price (€) | Advantages | Ideal for |
|---|---|---|---|---|
| Viscoelastic Class II mattress | Pressure sore prevention | 296.62 | Relieves pressure points, molds to body contours, improves comfort. | Long-term bedridden or high-risk patients. |
| Air mattress | Active treatment | 450.00 | Dynamic pressure redistribution, prevents and treats existing pressure sores. | Patients with pressure sores or prolonged bedriddenness. |
| Polyurethane foam mattress | Light prevention | 135.45 | Lightweight, easy to move, suitable for short recoveries. | Patients at moderate risk or temporary use. |
| Type of mattress | Composition | Advantages | Limitations | Ideal for |
|---|---|---|---|---|
| Viscoelastic mattress (Class II) | Made of memory foam, adapts to morphology by distributing pressure. | – Reduces pressure points. – Suitable for prolonged bedrest. – Superior comfort. |
– Not suitable for dynamic redistributions. – Higher cost. |
Patients at high risk of pressure sores or long-term bedridden. |
| Polyurethane foam mattress (Class IA) | Made of lightweight foam, sometimes with a waffle cut for better air circulation. | – Lightweight and easy to handle. – Suitable for moderate risks. – Ideal for short-term recovery. |
– Less effective for prolonged bedrest. – Not suitable for severe cases requiring intensive treatment. |
Patients at moderate risk or with temporary recovery. |
| Air mattress | Equipped with alternating air cells to reduce prolonged contact points. | – Active prevention and treatment of pressure sores. – Dynamic pressure redistribution. – Improves blood circulation. |
– More expensive. – Requires a compressor or pump, with regular maintenance. |
Patients with existing pressure sores or very high risks. |
What other medical equipment are reimbursed by Social Security?
In addition to LLPP mattresses, several other medical devices are reimbursed for people with specific needs. Here is a list of covered equipment, with their reimbursement bases and LLPP codes.
| Type of equipment | LLPP Code | Reimbursement base (€) | Comments |
|---|---|---|---|
| Medical bed | 6285133 | Up to 1,030 | Possible rental at €12.35/week. |
| Anti-pressure sore mattress | Variable | Between 137 and 300 | Depends on the model (viscoelastic, polyurethane, etc.). |
| Manual wheelchair | 4107723 | 558.99 | The base varies depending on the model and features. |
| Electric wheelchair | Variable | Between €2,800 and €4,000 | The amount depends on options such as tiltable backrest or standing feature. |
| Walker | 1285619 | 53.81 | Fixed or wheeled models covered. |
| Toilet chair with armrests and bucket | 1243302 | 102.62 | Includes models with or without wheels. |
| Pressure sore cushions | Variable | From €34.90 to €92 | Prevention for elbows, heels, or knees. |
| Patient lift | 1231782 | €17.53/week | Rented with reimbursement limited to 32 weeks. |
| Electric wheelchair for disabled | 1579613 | Up to €1,200 | Limited reimbursement for certain models. |
What procedures to follow for reimbursement?
Essential steps to obtain reimbursement
- Consult a doctor to obtain a prescription specifying the type of mattress.
- Buy a mattress that meets LLPP criteria.
- Send the necessary documents to your CPAM:
- Medical prescription.
- Purchase invoice.
- CERFA form.
| Step | Required document |
|---|---|
| Medical consultation | Prescription mentioning the product |
| Purchasing the mattress | Invoice and model references |
| Sending to CPAM | CERFA form and supporting documents |
Important points to remember
- LLPP mattresses are reimbursed every three years.
- The coverage also includes costs for delivery and protective cover.
Special cases: reimbursement for specific conditions
Some patients benefit from enhanced reimbursement in specific situations:
- Long-Term Illness (ALD): Patients recognized with ALD can receive 100% reimbursement of the tariff base.
- Disability: People with disabilities needing permanent assistance can also claim full reimbursement.
- Severe pathologies: In some cases (polyarthritis, multiple sclerosis, etc.), air mattresses are often reimbursed to prevent complications related to immobility.
Why is your mutual insurance essential?
Health mutual insurance plays a crucial role in covering the remaining costs after the reimbursement from social security. Some mutual insurances cover up to 100% of costs, limiting your out-of-pocket expenses.
| Coverage type | Amount covered (%) |
|---|---|
| Health Insurance | 60% |
| Health mutual insurance | Up to 40% or more |
How to choose an appropriate mattress?
Selecting a LLPP mattress must consider several criteria:
- Patient’s weight: Some mattresses have specific weight limits, such as viscoelastic mattresses suitable for people weighing between 40 and 100 kg.
- Duration of immobility: Air mattresses are preferable for patients in continuous bedrest, while foam mattresses suit short-term immobilizations.
- Pressure sore risk level:
- Low risk: polyurethane foam mattresses.
- High risk: viscoelastic or air mattresses.
- Medical advice: Consultation with a specialist is essential to determine the most suitable mattress.
The role of health professionals in the process
Health professionals play a key role in identifying and addressing patients’ needs:
- Prescribing doctors: Assess pressure sore risks using scales like Norton’s. They also specify the mattress details in the prescription.
- Nurses: Monitor the patient’s condition and adapt recommendations if needed.
- Authorized providers: Ensure delivery, installation, and sometimes maintenance of the mattresses.
Frequently Asked Questions about LLPP mattress reimbursement
1. How long is the coverage for an LLPP mattress?
Coverage is limited to one mattress every three years, unless otherwise indicated by a doctor.
2. Can I replace the mattress before three years?
A new reimbursement before the three-year limit is only possible in case of significant deterioration of the mattress or changes in the patient’s medical needs.
3. What is the difference between purchasing and renting a mattress?
- Purchase: Long-term solution, often more economical for patients needing prolonged use.
- Rental: Ideal for temporary needs, especially after hospitalization.
4. Are delivery costs included in the reimbursement?
Yes, social security coverage often includes delivery and installation costs.
Conclusion: reimbursement under specific conditions
Reimbursement for an LLPP mattress is an essential aid for individuals with dependence or disability. However, it is important to meet eligibility criteria and provide the necessary documents to benefit from this support.
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