Medicare Wound Care Guidelines
Medicare covers wound care supplies or surgical dressings when they are medically necessary. Medicare will pay for 80 percent of the cost after you meet your deductible. You will also pay a copayment if you receive treatment in a hospital outpatient setting.
When Does Medicare Cover Wound Care Supplies?
Wound care supplies are covered in some circumstances. Treatment covered under Medicare must be medically necessary and used for a surgical or surgically treated wound.
You pay nothing for the actual supplies but must meet the Part B deductible. After meeting the deductible, you will be responsible for 20 percent of the cost of treatment as well as a copayment if you receive care in a hospital outpatient setting.
- Surgical wounds that must be left open
- Infected open wounds that result from surgery or trauma
- Biofilm wounds
- Autoimmune disorder wounds
- Necrotic tissue wounds
Wound care is usually for injuries that do not improve independently or take an unusually long time to heal.
According to the U.S. National Library of Medicine, this typically includes a wound that has not healed within six weeks or at least started to heal after two weeks.
Remember that just because you are staying in a hospital does not mean that you are automatically an inpatient. Check with your doctor to determine your patient status if you plan to receive treatment in a hospital.
Wound Care Supplies Covered by Medicare
Medicare covers wound care dressings for injuries treated by a surgical procedure or after the removal of dead skin and tissue.
Wound care supplies are not covered when needed for less serious conditions, such as burns, stage 1 pressure ulcers and wounds caused by trauma but don’t need to be surgically closed, like a skin tear.
- Gauze used to clean a wound, later removed
- Skin sealant
- Small adhesive bandages
- Surgical stockings
- Topical antibiotics
- Wound cleansers
More wound care supply options could be available through a Medicare Advantage plan, which private insurance companies provide. These plans include everything covered within Original Medicare and additional benefits.
Check with your provider to learn if additional wound care supplies or expanded coverage could be available through a Medicare Advantage plan.
Medicare Wound Care Documentation Requirements
There are Medicare documentation requirements that need to be met to cover wound care and supplies.
These documents detail your signs and symptoms to justify wound care as medically necessary, and demonstrate that treatment can positively impact the wound and its healing.
In the documentation, the status of your wound – such as its response to any treatment or supplies – is recorded. Other information about the injury, like its location, size and depth, should also be notated.
Your doctor may need additional information, such as a treatment plan, to document for Medicare to pay for care and supplies.
8 Cited Research Articles
- U.S. National Library of Medicine. (2021, June 9). Wound care centers. Retrieved from https://medlineplus.gov/ency/patientinstructions/000739.htm
- U.S. Centers for Medicare & Medicaid Services. (February 2021). Provider Compliance Tips for Surgical Dressings. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ProviderComplianceTipsforSurgicalDressings-ICN909475Print-Friendly.pdf
- U.S. Centers for Medicare & Medicaid Services. (2021, January 28). Proposed Local Coverage Determination (LCD): Wound Care. Retrieved from https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=38901&ContrId=364
- U.S. National Library of Medicine. (2015, March). Chronic wound repair and healing in older adults: current status and feature research. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25753048/
- U.S. National Library of Medicine. (2014, August 1). Medicare Payment: Surgical Dressings and Topical Wound Care Products. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121050/
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Local Coverage Article: Surgical Dressings – Policy Article. Retrieved from https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleid=54563&ver=38&bc=CAAAAAAAAAAA
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Local Coverage Determination (LCD): Wound Care. Retrieved from https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=37166&ver=22&Date=&DocID=L37166&bc=hAAAAAgAAAAA&
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Surgical dressing services. Retrieved from https://www.medicare.gov/coverage/surgical-dressing-services