In summary
| 📋 Section | Description |
|---|---|
| 🔎 Introduction | LPP mattresses play a crucial role in preventing or relieving pressure ulcers. Their reimbursement reduces costs for patients in dependency situations. |
| 🛏️ What is an LPP mattress? | A medical device designed to prevent pressure ulcers, prescribed in cases of prolonged immobilization. |
| ✔️ Eligibility criteria | The mattress must be registered on the LPP list, prescribed by a doctor, and meet specific medical indications such as a risk assessed on the Norton scale. |
| 💰 Reimbursement rate | Rates vary depending on the type of mattress, generally 60% covered by Health Insurance, with possible additional coverage by a mutual insurance company. |
| 📊 Model comparison | Comparison between viscoelastic, air, and polyurethane foam mattresses in terms of cost, advantages, and recommended use. |
| 🔄 Other reimbursed equipment | List of reimbursed medical devices, such as wheelchairs, walkers, or anti-pressure ulcer cushions, with their reimbursement bases. |
| 📝 Procedures for reimbursement | Steps to obtain reimbursement: medical prescription, invoice, CERFA form to send to CPAM. |
| 📌 Special cases | Enhanced reimbursements for patients with ALD, disabilities, or severe pathologies. |
| 💡 Importance of 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 weight, duration of immobilization, risk of pressure ulcers, and medical recommendations. |
| 👩⚕️ Role of healthcare professionals | Doctors, nurses, and certified providers assist patients in choosing, prescribing, and installing mattresses. |
| ❓ Frequently Asked Questions | FAQ about coverage conditions, validity period, the difference between renting and buying, and included costs. |
| 📝 Conclusion | The reimbursement of an LPP mattress is essential to reduce dependency-related costs but requires meeting eligibility criteria. |
The LPP mattresses (List of Reimbursable Products and Services) play a vital role for individuals with specific medical needs, especially those facing pressure ulcers or pain related 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 steps to follow to benefit from this aid.
What is an LPP mattress and why is it reimbursed?
An LPP (List of Reimbursable Products and Services) mattress is designed to meet specific medical needs, particularly to prevent or relieve pressure ulcers. These medical devices are prescribed by a doctor in situations where the patient must remain in bed for extended periods.
Criteria for eligibility for reimbursement
For a mattress to be covered by Social Security, it must:
- Be registered on the List of Products and Services.
- Meet specific medical indications such as an ulcer risk evaluated on the Norton scale.
- Be prescribed by a specialist doctor.
| Required criteria | Details |
|---|---|
| Registration on the LPP list | Yes |
| Medical prescription | Mandatory |
| Risk assessment | Score ≤ 14 on the Norton scale or equivalent |
What are the reimbursement rates for LPP mattresses?
The reimbursement rate depends on the type of mattress and the eligibility conditions. Generally, Health Insurance covers 60% of the base price, with additional coverage possible by a mutual insurance company.
| 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 cost may be covered by a supplementary mutual insurance.
Comparison of different mattress models
This table helps compare the main features of various types of LPP mattresses:
| Model | Type | Price (€) | Advantages | Ideal for |
|---|---|---|---|---|
| Viscoelastic class II mattress | Pressure ulcer prevention | 296.62 | Relieves pressure points, molds to the body’s contours, improves comfort. | Patients who are bedridden for long periods or at high risk. |
| Air mattress | Active treatment | 450.00 | Dynamic pressure redistribution, prevents and treats existing pressure ulcers. | Patients with pressure ulcers or prolonged bedrest. |
| Polyurethane foam mattress | Light prevention | 135.45 | Lightweight, easy to move, suitable for short-term recovery. | Patients at moderate risk or temporary use. |
| Type of mattress | Composition | Advantages | Limitations | Ideal for |
|---|---|---|---|---|
| Viscoelastic mattress (Class II) | Made of memory foam that adapts to morphology by distributing pressure. | – Reduces pressure points. – Suitable for prolonged bedrest. – Superior comfort. |
– Not suitable for dynamic redistribution. – Higher cost. |
Patients at high risk of pressure ulcers or long-term bedridden individuals. |
| Polyurethane foam mattress (Class IA) | Made of lightweight foam, sometimes with a waffle cut for better air circulation. | – Light 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 for temporary recovery. |
| Air mattress | Equipped with alternating air cells to reduce prolonged contact points. | – Active prevention and treatment of pressure ulcers. – Dynamic redistribution of pressure. – Improves blood circulation. |
– More expensive. – Requires a compressor or pump, with regular maintenance. |
Patients with existing pressure ulcers or very high risks. |
What other medical equipment are reimbursed by Social Security?
In addition to LPP mattresses, several other medical devices are reimbursed for individuals with specific needs. Here is a list of accepted equipment, with their reimbursement bases and LPP codes.
| Type of equipment | LPP Code | Reimbursement base (€) | Comments |
|---|---|---|---|
| Hospital bed | 6285133 | Up to 1,030 | Possible rental at 12.35 €/week. |
| Pressure ulcer cushions | Variable | Between 137 and 300 | Depends on the model (viscoelastic, polyurethane, etc.). |
| Manual wheelchair | 4107723 | 558.99 | The base varies according to model and features. |
| Electric wheelchair | Variable | Between 2,800 and 4,000 | The amount depends on options like reclining backrest or verticalization. |
| Walker | 1285619 | 53.81 | Fixed or rolling models covered. |
| Commode with armrests and bucket | 1243302 | 102.62 | Includes models with or without wheels. |
| Pressure ulcers cushions | Variable | From 34.90 to 92 | Prevention for elbows, heels, or knees. |
| Patient lift | 1231782 | 17.53/week | Rented, reimbursed within a limit of 32 weeks. |
| Electric scooter for disabled person | 1579613 | Up to 1,200 | Reimbursement limited to certain models. |
What procedures to follow for reimbursement?
Essential steps to obtain reimbursement
- Consult a doctor to get a prescription specifying the type of mattress.
- Buy a mattress compliant with LPP criteria.
- Send necessary documents to your CPAM:
- Medical prescription.
- Purchase receipt.
- 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
- LPP mattresses are reimbursed every three years.
- Coverage also includes delivery costs and protective covers.
Special cases: reimbursement for specific conditions
Some patients benefit from enhanced reimbursement in specific situations:
- Long-Term Illnesses (ALD): Patients recognized with ALD can receive 100% reimbursement based on the tariff.
- Disability: People with disabilities who need permanent assistance can also claim full reimbursement.
- Serious conditions: 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 remaining costs after Social Security reimbursement. Some mutuals cover up to 100% of costs, reducing your out-of-pocket expenses.
| Coverage type | Amount covered (%) |
|---|---|
| Health Insurance | 60% |
| Mutual insurance | Up to 40% or more |
How to choose an appropriate mattress?
Choosing an LPP mattress must consider several criteria:
- Patient weight: Some mattresses have specific weight limits, such as viscoelastic mattresses suitable for people weighing between 40 and 100 kg.
- Duration of immobilization: Air mattresses are preferable for continuous bedrest, while foam mattresses are suitable for short-term immobilizations.
- Pressure ulcer risk level:
- Low risk: polyurethane foam mattress.
- High risk: viscoelastic or air mattresses.
- Doctor’s advice: A consultation with a specialist is essential to determine the most suitable mattress.
The role of health professionals in the process
The health professionals play a key role in identifying and managing patient needs:
- Prescribing doctors: Assess pressure ulcer risks using scales like Norton. They also specify mattress details in the prescription.
- Nurses: Monitor patient status and adjust recommendations if needed.
- Certified providers: Ensure delivery, installation, and sometimes maintenance of mattresses.
Frequently Asked Questions about LPP mattress reimbursement
1. How long is an LPP mattress covered?
Coverage is limited to one mattress every three years, unless otherwise specified by a doctor.
2. Can I change 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 change in the patient’s medical needs.
3. What is the difference between buying and renting a mattress?
- Buying: Long-term solution, often more economical for patients needing prolonged use.
- Renting: Ideal for temporary needs, especially after hospitalization.
4. Are delivery costs included in the reimbursement?
Yes, reimbursement by Social Security often includes delivery and installation costs.
Conclusion: reimbursement with specific conditions
Reimbursement for an LPP mattress is an essential aid for those in dependency or with disabilities. However, it’s important to meet eligibility criteria and submit the necessary documents to benefit from this support.
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