Wound Care
Medicare Guidelines
DRESSING | MAXIMUM FREQUENCY | DRAINAGE | THICKNESS/STAGE | SPECIAL COMMENTS |
|---|---|---|---|---|
Gauze | Up to 3x/Day | Any | Any | |
Roll Gauze | Up to 3x/Day | Any | Any | |
Bordered Gauze | Up to 1x/Day | Any | Any | |
Composite Dressing | Up to 3x/Week | Any | Any | |
Impregnated Gauze | Up to 1x/Day | Any | Any | |
Contact Layer | Up to 1x/Week | Any | Any | |
Hydrocolloid Dressing | Up to 3x/Week | Minimal/Mod | Any | |
Transparent Film | Up to 3x/Week | Minimal Partial Thickness | ||
Specialty Absorptive Dressing Without Border | Up to 1x/Day | Mod/Heavy | **Full Thickness/Stage 3 or 4 | |
Specialty Absorptive Dressing With Border | Up to 1x/Every Other Day | Mod/Heavy | **Full Thickness/Stage 3 or 4 | |
Calcium Alginate Dressing | Up to 1x/Day | Mod/Heavy | **Full Thickness/Stage 3 or 4 | Includes Silver Alginates |
Foam/Bordered Foam Dressing | Up to 3x/Week | Mod/Heavy | **Full Thickness/Stage 3 or 4 | Includes Silver Foams |
Hydrogel Filler (Tube) | Up to 3 ounces/Month | None/Minimal | **Full Thickness/Stage 3 or 4 | Wound must have cavity |
Hydrogel Gauze/Sheet | Up to 1x/Day | None/Minimal | **Full Thickness/Stage 3 or 4 |
Medicare will cover a primary and secondary surgical dressing for each wound, if the wound qualifies for Part B benefits and the product type and quantity are medically necessary for the specific characteristics of the wound.
* Partial Thickness/Stage 2: Skin loss involving epidermis, dermis or both. The ulcer is superficial and presents clinically as an abrasion, blister or shallow crater.
** Full Thickness/Stage 3: Skin loss involving damage to, or necrosis of subcutaneous tissue that may extend down to, but not through underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.
*** Full Thickness/Stage 4: Skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures (e.g. tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage 4 pressure ulcers.
Dressing size must be based on and appropriate to the size of the wound.
Unless otherwise noted, the information on this page was obtained from the Centers for Medicare & Medicaid Services (Local Coverage Determination for Surgical Dressings – L11460). Be advised that information contained herein is intended to serve as a useful reference for Informational purposes only and is not information or guarantee of coverage. This information is intended for use only by competent healthcare professionals exercising judgement in providing care. Gaboro Medical Supply cannot be held responsible for the continued currency of or any errors or omissions in the information.
