Medicare Wound Care Guidelines

Medicare covers wound care supplies or surgical dressings when they are medically necessary. Medicare will pay for 80% of the cost after you meet your deductible. You will also pay a copayment if you receive treatment in a hospital outpatient setting.

Christian Simmons, writer and researcher for RetireGuide
  • Written by
    Christian Simmons

    Christian Simmons

    Financial Writer

    Christian Simmons is a writer for RetireGuide and a member of the Association for Financial Counseling & Planning Education (AFCPE®). He covers Medicare and important retirement topics. Christian is a former winner of a Florida Society of News Editors journalism contest and has written professionally since 2016.

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  • Edited By
    Lee Williams
    Lee Williams, senior editor for RetireGuide.com

    Lee Williams

    Senior Financial Editor

    Lee Williams is a professional writer, editor and content strategist with 10 years of professional experience working for global and nationally recognized brands. He has contributed to Forbes, The Huffington Post, SUCCESS Magazine, AskMen.com, Electric Literature and The Wall Street Journal. His career also includes ghostwriting for Fortune 500 CEOs and published authors.

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  • Published: June 30, 2021
  • Updated: June 23, 2023
  • 4 min read time
  • This page features 8 Cited Research Articles
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APA Simmons, C. (2023, June 23). Medicare Wound Care Guidelines. RetireGuide.com. Retrieved June 17, 2024, from https://www.retireguide.com/medicare/treatments/wound-care/

MLA Simmons, Christian. "Medicare Wound Care Guidelines." RetireGuide.com, 23 Jun 2023, https://www.retireguide.com/medicare/treatments/wound-care/.

Chicago Simmons, Christian. "Medicare Wound Care Guidelines." RetireGuide.com. Last modified June 23, 2023. https://www.retireguide.com/medicare/treatments/wound-care/.

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Wound Care Coverage at a Glance
Medicare PlanWound Care Coverage
Part A (Inpatient)Covers hospital inpatient wound care after you meet your Part A deductible.
Part B (Outpatient)80% of wound care costs for medically necessary supplies after you meet your Part B deductible.
Part C (Medicare Advantage)Mirrors Part A and Part B coverage but may provide additional benefits.
Part D (Prescription Drugs)N/A
Supplemental Insurance May cover out-of-pocket costs associated with Medicare. Coverage varies by plan.

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% of the cost of treatment as well as a copayment if you receive care in a hospital outpatient setting.

Types of Wounds That Medicare Covers
  • 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.

Medicare Part A covers care if you are an inpatient at a hospital or a skilled nursing facility. Wound care could be covered under Part A as well, but only under these circumstances.

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.

Wound Care Supplies Not Covered by Medicare
  • 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.

Medicare Wound Care Coverage FAQs

Does Medicare pay for a wound care nurse?
Medicare Part B covers outpatient wound care in your doctor’s office or skilled nursing facility. It only covers occasional wound care nursing services, including in-home skilled nursing care.
Will Medicare pay for a wound VAC?
Medicare Part B will cover a vacuum-assisted closure of a wound — also called a wound VAC — for eligible patients. These procedures use a device that reduces air pressure on the wound, in some cases allowing it to heal more quickly.
Which wound care supplies are covered by Medicare?
Medicare covers wound care supplies and dressings for surgical wounds or after the removal of dead tissue and skin. Medicare does not cover certain wound care supplies such as gauze used to clean a wound, small adhesive bandages, skin sealant, topical antibiotics, wound cleansers or surgical stockings.
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Last Modified: June 23, 2023

8 Cited Research Articles

  1. U.S. National Library of Medicine. (2022, April 17). Wound care centers. Retrieved from https://medlineplus.gov/ency/patientinstructions/000739.htm
  2. 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
  3. 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/view/lcd.aspx?LCDId=38901&ContrId=364
  4. 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/
  5. 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/
  6. 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/view/article.aspx?articleid=54563&ver=38&bc=CAAAAAAAAAAA
  7. U.S. Centers for Medicare & Medicaid Services. (n.d.). Local Coverage Determination (LCD): Wound Care. Retrieved from https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=37166&ver=22&Date=&DocID=L37166&bc=hAAAAAgAAAAA&
  8. U.S. Centers for Medicare & Medicaid Services. (n.d.). Surgical dressing services. Retrieved from https://www.medicare.gov/coverage/surgical-dressing-services