Medicare Guidelines for Wound Care Supplies
When ordering wound care supplies, you may need to know Medicare guidelines to see what can be covered by insurance. Cheryl Hutton, a wound, ostomy and continence nurse with CHC Solutions, Inc., informed us of what we need to know.
Medicare refers to wound care supplies as “surgical dressings.” Surgical dressings are covered when a qualifying wound is present. A qualifying wound is defined as either of the following:
- A wound caused by or treated by a surgical procedure
- A wound that requires debridement, regardless of the debridement technique
Products that are eligible to be classified as surgical dressings include:
- Primary dressings – Defined as therapeutic or protective coverings applied directly to wounds or lesions either on the skin or caused by an opening to the skin
- Secondary dressings – Defined as materials that serve a therapeutic or protective function, and they secure a primary dressing
For Medicare surgical dressing reimbursement, the dressing size must be appropriate to the size of the wound. For example, you cannot use a 10”x10” dressing over a one-inch diameter wound.
Wound Care Orders
When ordering wound care supplies, your doctor must send a written, signed and dated order to the supplier. The supplier needs this before they can submit the claim for payment to the insurance. Also, the order must specify several things:
- Type of dressing
- Size of the dressing
- Number or amount needed at one time
- Frequency of the dressing change
- Expected duration you will need the supplies
For every dressing, the order must be updated at least every three months. You may need to see your doctor or healthcare professional monthly for regular wound assessment.
Required Clinical Documentation
When your doctor sends an order, they must include the following information:
- Number of surgical/debrided wounds treated with a dressing
- Reason for the dressing
- Whether the dressing is primary or secondary
- Clinical information that is up-to-date and supports the necessity of the type and amount of surgical dressings
- Documentation of at least monthly wound evaluations (more frequent for those in nursing facilities or with heavily draining/infected wounds)
Monthly Wound Assessments Must Include:
- Type of wounds
- Size (Length x Width x Depth in cm.)
- Drainage Amount
To learn more about wound care, visit our blog page at https://www.chcsolutions.com/continuum_connect/wound-care/. In addition, to learn more about wound care at home, visit https://www.chcsolutions.com/continuum_connect/wound-care/conversations-with-clinicians-wound-care-at-home/.
*Disclaimer: Any health and wellness content presented is for general informational purposes only. Such content is not intended to replace or serve as a substitute for professional medical advice, diagnosis or treatment.