Having trouble finding the Wound Care / Surgical Supplies you need or finding a supplier that will accept Medicare Assignment?
Better Living Now is here to help you. We carry all your supplies and we work with you towards providing your supplies under Medicare assignment through our Preferred Program.
If you are covered under Medicare, many of your medically necessary supplies and related products may be covered!
To get started enroll today or print out an Wound Care / Surgical Supplies Order Form, bring it to your doctor and mail your or fax your order to us. It is that easy!
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Wound Care / Surgical Supplies Allowable Amounts
Better Living Now has developed preferred product relationships with industry leading manufacturers in an effort to bring you the highest quality products available that will be 100% covered by your insurance/Medicare plan with no additional out-of-pocket expense to you. Contact us for more informationWound Care / Surgical Supplies Allowable Amounts - Effective 02/04/2011
Product Description
Allowable Amount
A4450 TAPE, NON-WATERPROOF, PER 18 SQUARE INCHES
A4452 TAPE, WATERPROOF, PER 18 SQUARE INCHES
A4461 SURGICAL DRESSING HOLDER, NON-REUSABLE, EACH
A4463 SURGICAL DRESSING HOLDER, REUSABLE, EACH
A4465 NON-ELASTIC BINDER FOR EXTREMITY
A4490 SURGICAL STOCKINGS ABOVE KNEE LENGTH, EACH
A4495 SURGICAL STOCKINGS THIGH LENGTH, EACH
A4500 SURGICAL STOCKINGS BELOW KNEE LENGTH, EACH
A4510 SURGICAL STOCKINGS FULL LENGTH, EACH
A4649 SURGICAL SUPPLY; MISCELLANEOUS
A6010
COLLAGEN BASED WOUND FILLER, DRY FORM, STERILE, PER GRAM OF COLLAGEN
A6011
COLLAGEN BASED WOUND FILLER, GEL/PASTE, PER GRAM OF COLLAGEN
A6021
COLLAGEN DRESSING, STERILE, PAD SIZE 16 SQ. IN. OR LESS, EACH
A6022
COLLAGEN DRESSING, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH
A6023
COLLAGEN DRESSING, STERILE, PAD SIZE MORE THAN 48 SQ. IN., EACH
A6024
COLLAGEN DRESSING WOUND FILLER, STERILE, PER 6 INCHES
A6025
GEL SHEET FOR DERMAL OR EPIDERMAL APPLICATION, (E.G., SILICONE, HYDROGEL, OTHER), EACH
A6154 WOUND POUCH, EACH
A6196
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, EACH DRESSING
A6197
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING
A6198
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., EACH DRESSING
A6199
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND FILLER, STERILE, PER 6 INCHES
A6203
COMPOSITE DRESSING, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6204
COMPOSITE DRESSING, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6205
COMPOSITE DRESSING, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6206
CONTACT LAYER, STERILE, 16 SQ. IN. OR LESS, EACH DRESSING
A6207
CONTACT LAYER, STERILE, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING
A6208
CONTACT LAYER, STERILE, MORE THAN 48 SQ. IN., EACH DRESSING
A6209
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
A6210
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6211
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6212
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6213
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6214
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6215 FOAM DRESSING, WOUND FILLER, STERILE, PER GRAM
A6216
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
A6217
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6218
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6219
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6220
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6221
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6222
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
A6223
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, PAD SIZE MORE THAN 16 SQ. IN., BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6224
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6228
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
A6229
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6230
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6231
GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, STERILE, PAD SIZE 16 SQ. IN. OR LESS, EACH DRESSING
A6232
GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, STERILE, PAD SIZE GREATER THAN 16 SQ. IN., BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING
A6233
GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, STERILE, PAD SIZE MORE THAN 48 SQ. IN., EACH DRESSING
A6234
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
A6235
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6236
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6237
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6238
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6239
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6240
HYDROCOLLOID DRESSING, WOUND FILLER, PASTE, STERILE, PER OUNCE
A6241
HYDROCOLLOID DRESSING, WOUND FILLER, DRY FORM, STERILE, PER GRAM
A6242
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
A6243
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6244
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6245
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6246
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6247
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6248
HYDROGEL DRESSING, WOUND FILLER, GEL, PER FLUID OUNCE
A6250
SKIN SEALANTS, PROTECTANTS, MOISTURIZERS, OINTMENTS, ANY TYPE, ANY SIZE
A6251
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
A6252
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6253
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6254
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6255
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6256
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
A6257 TRANSPARENT FILM, STERILE, 16 SQ. IN. OR LESS, EACH DRESSING
A6258
TRANSPARENT FILM, STERILE, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING
A6259 TRANSPARENT FILM, STERILE, MORE THAN 48 SQ. IN., EACH DRESSING
A6260
WOUND CLEANSERS, ANY TYPE, ANY SIZE
A6261
WOUND FILLER, GEL/PASTE, PER FLUID OUNCE, NOT OTHERWISE SPECIFIED
A6262
WOUND FILLER, DRY FORM, PER GRAM, NOT OTHERWISE SPECIFIED
A6266
GAUZE, IMPREGNATED, OTHER THAN WATER, NORMAL SALINE, OR ZINC PASTE, STERILE, ANY WIDTH, PER LINEAR YARD
A6402
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
A6403
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 16 SQ. IN. LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6404
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
A6407
PACKING STRIPS, NON-IMPREGNATED, STERILE, UP TO 2 INCHES IN WIDTH, PER LINEAR YARD
A6410 EYE PAD, STERILE, EACH
A6411 EYE PAD, NON-STERILE, EACH
A6412 EYE PATCH, OCCLUSIVE, EACH
A6413 ADHESIVE BANDAGE, FIRST-AID TYPE, ANY SIZE, EACH
A6441
PADDING BANDAGE, NON-ELASTIC, NON-WOVEN/NON-KNITTED, WIDTH GREATER THAN OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD
A6442
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH LESS THAN THREE INCHES, PER YARD
A6443
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD
A6444
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN OR EQUAL TO 5 INCHES, PER YARD
A6445
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH LESS THAN THREE INCHES, PER YARD
A6446
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD
A6447
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR EQUAL TO FIVE INCHES, PER YARD
A6448
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH LESS THAN THREE INCHES, PER YARD
A6449
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD
A6450
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL TO FIVE INCHES, PER YARD
A6451
MODERATE COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE OF 1.25 TO 1.34 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD
A6452
HIGH COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE GREATER THAN OR EQUAL TO 1.35 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD
A6453
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH LESS THAN THREE INCHES, PER YARD
A6454
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD
A6455
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR EQUAL TO FIVE INCHES, PER YARD
A6456
ZINC PASTE IMPREGNATED BANDAGE, NON-ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD
A6457 TUBULAR DRESSING WITH OR WITHOUT ELASTIC, ANY WIDTH, PER LINEAR YARD
A6501
COMPRESSION BURN GARMENT, BODYSUIT (HEAD TO FOOT), CUSTOM FABRICATED
A6504
COMPRESSION BURN GARMENT, GLOVE TO WRIST, CUSTOM FABRICATED
A6505
COMPRESSION BURN GARMENT, GLOVE TO ELBOW, CUSTOM FABRICATED
A6506 COMPRESSION BURN GARMENT, GLOVE TO AXILLA, CUSTOM FABRICATED
A6507
COMPRESSION BURN GARMENT, FOOT TO KNEE LENGTH, CUSTOM FABRICATED
A6508
COMPRESSION BURN GARMENT, FOOT TO THIGH LENGTH, CUSTOM FABRICATED
A6509
COMPRESSION BURN GARMENT, UPPER TRUNK TO WAIST INCLUDING ARM OPENINGS (VEST), CUSTOM FABRICATED
A6510
COMPRESSION BURN GARMENT, TRUNK, INCLUDING ARMS DOWN TO LEG OPENINGS (LEOTARD), CUSTOM FABRICATED
A6511
COMPRESSION BURN GARMENT, LOWER TRUNK INCLUDING LEG OPENINGS (PANTY), CUSTOM FABRICATED
A6512 COMPRESSION BURN GARMENT, NOT OTHERWISE CLASSIFIED
A6513
COMPRESSION BURN MASK, FACE AND/OR NECK, PLASTIC OR EQUAL, CUSTOM FABRICATED
A6530
GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH
A6531
GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH
A6532
GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH
A6533
GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH
A6534
GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH
A6535
GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH
A6536
GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH
A6537
GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH
A6538
GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH
A6539
GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH
A6540
GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH
A6541
GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH
A6544
GRADIENT COMPRESSION STOCKING, GARTER BELT
A6545
GRADIENT COMPRESSION WRAP, NON-ELASTIC, BELOW KNEE, 30-50 MM HG, EACH
A6549
GRADIENT COMPRESSION STOCKING/SLEEVE, NOT OTHERWISE SPECIFIED
A9270 NON-COVERED ITEM OR SERVICE
Notes - none
Wound Care / Surgical Supplies Guidelines
General InformationFor more information on local coverage determination Local Coverage Determination (LCD) for Wound Care / Surgical SuppliesIndications and Limitations of Coverage and/or Medical Necessity
For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable
and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body
member, and 3) meet all other applicable Medicare statutory and regulatory requirements. For the items addressed in
this local coverage determination, the criteria for "reasonable and necessary", based on Social Security Act §
1862(a)(1)(A) provisions, are defined by the following indications and limitations of coverage and/or medical necessity.
If the coverage criteria described below are not met, the claim will be denied as not reasonable and necessary.
For an item to be covered by Medicare, a written signed and dated order must be received by the supplier before a claim
is submitted. If the supplier bills for an item without first receiving the completed order, the item will be denied as not
reasonable and necessary.
Surgical dressings are covered for as long as they are medically necessary. Dressings over a percutaneous catheter or
tube (e.g., intravascular, epidural, nephrostomy, etc.) are covered as long as the catheter or tube remains in place and
after removal until the wound heals. (Refer to Coding Guidelines in the associated Policy Article)
Surgical dressings used in conjunction with investigational wound healing therapy (e.g., platelet derived wound healing
formula) may be covered if all applicable coverage criteria are met based on the number and type of surgical dressings
that are appropriate to treat the wound if the investigational therapy were not being used.
When a wound cover with an adhesive border is being used, no other dressing is needed on top of it and additional tape
is usually not required. Reasons for use of additional tape must be well documented. An adhesive border is usually more
binding than that obtained with separate taping and is therefore indicated for use with wounds requiring less frequent
dressing changes.
Use of more than one type of wound filler or more than one type of wound cover in a single wound is rarely medically
necessary and the reasons must be well documented. An exception is an alginate or other fiber gelling dressing wound
cover or a saline, water, or hydrogel impregnated gauze dressing which might need an additional wound cover.
It may not be appropriate to use some combinations of a hydrating dressing on the same wound at the same time as an
absorptive dressing (e.g., hydrogel and alginate).
Because composite dressings, foam and hydrocolloid wound covers, and transparent film, when used as secondary
dressings, are meant to be changed at frequencies less than daily, appropriate clinical judgment should be used to avoid
their use with primary dressings which require more frequent dressing changes. When claims are submitted for these
dressings for changes greater than once every other day, the quantity in excess of that amount will be denied as not
reasonable and necessary. While a highly exudative wound might require such a combination initially, with continued
proper management the wound usually progresses to a point where the appropriate selection of these products results in
the less frequent dressing changes which they are designed to allow. An example of an inappropriate combination is the
use of a specialty absorptive dressing on top of non-impregnated gauze being used as a primary dressing.
Dressing size must be based on and appropriate to the size of the wound. For wound covers, the pad size is usually
about 2 inches greater than the dimensions of the wound. For example, a 5 cm x 5 cm (2 in. x 2 in.) wound requires a 4
in. x 4 in. pad size.
The quantity and type of dressings dispensed at any one time must take into account the current status of the wound(s),
the likelihood of change, and the recent use of dressings.
Dressing needs may change frequently (e.g., weekly) in the early phases of wound treatment and/or with heavily
draining wounds. Suppliers are also expected to have a mechanism for determining the quantity of dressings that the
patient is actually using and to adjust their provision of dressings accordingly. No more than a one month's supply of
dressings may be provided at one time, unless there is documentation to support the necessity of greater quantities in
the home setting in an individual case. An even smaller quantity may be appropriate in the situations described above.
Surgical dressings must be tailored to the specific needs of an individual patient. When surgical dressings are provided
in kits, only those components of the kit that meet the definition of a surgical dressing, that are ordered by the physician,
and that are medically necessary are covered.
The following are some specific coverage guidelines for individual products when the products themselves are
necessary in the individual patient. The medical necessity for more frequent change of dressing must be documented in
the patient's medical record and submitted with the claim. (see Documentation section).
ALGINATE OR OTHER FIBER GELLING DRESSING (A6196-A6199):
Alginate or other fiber gelling dressing covers are covered for moderately to highly exudative full thickness wounds (e.g.,
stage III or IV ulcers); and alginate or other fiber gelling dressing fillers for moderately to highly exudative full thickness
wound cavities (e.g., stage III or IV ulcers). They are not medically necessary on dry wounds or wounds covered with
eschar. Usual dressing change is up to once per day. One wound cover sheet of the approximate size of the wound or
up to 2 units of wound filler (1 unit = 6 inches of alginate or other fiber gelling dressing rope) is usually used at each
dressing change. It is usually inappropriate to use alginates or other fiber gelling dressings in combination with
hydrogels.
COMPOSITE DRESSING (A6203-A6205):
Usual composite dressing change is up to 3 times per week, one wound cover per dressing change.
CONTACT LAYER (A6206-A6208):
Contact layer dressings are used to line the entire wound; they are not intended to be changed with each dressing
change. Usual dressing change is up to once per week.
FOAM DRESSING (A6209-A6215):
Foam dressings are covered when used on full thickness wounds (e.g., stage III or IV ulcers) with moderate to heavy
exudate. Usual dressing change for a foam wound cover used as a primary dressing is up to 3 times per week. When a
foam wound cover is used as a secondary dressing for wounds with very heavy exudate, dressing change may be up to
3 times per week. Usual dressing change for foam wound fillers is up to once per day.
GAUZE, NON-IMPREGNATED (A6216-A6221, A6402-A6404, A6407):
Usual non-impregnated gauze dressing change is up to 3 times per day for a dressing without a border and once per
day for a dressing with a border. It is usually not necessary to stack more than 2 gauze pads on top of each other in any
one area.
GAUZE, IMPREGNATED, WITH OTHER THAN WATER, NORMAL SALINE, HYDROGEL, OR ZINC PASTE (A6222-A6224, A6266):
Usual dressing change for gauze dressings impregnated with other than water, normal saline, hydrogel, or zinc paste is
up to once per day.
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE (A6228-A6230):
There is no medical necessity for these dressings compared to non-impregnated gauze which is moistened with bulk
saline or sterile water. When these dressings are billed, they will be denied as not reasonable and necessary.
HYDROCOLLOID DRESSING (A6234-A6241):
Hydrocolloid dressings are covered for use on wounds with light to moderate exudate. Usual dressing change for
hydrocolloid wound covers or hydrocolloid wound fillers is up to 3 times per week.
HYDROGEL DRESSING (A6231-A6233, A6242-A6248):
Hydrogel dressings are covered when used on full thickness wounds with minimal or no exudate (e.g., stage III or IV
ulcers). Hydrogel dressings are not usually medically necessary for stage II ulcers. Documentation must substantiate the
medical necessity for use of hydrogel dressings for stage II ulcers (e.g., location of ulcer is sacro-coccygeal area). Usual
dressing change for hydrogel wound covers without adhesive border or hydrogel wound fillers is up to once per day.
Usual dressing change for hydrogel wound covers with adhesive border is up to 3 times per week.
The quantity of hydrogel filler used for each wound must not exceed the amount needed to line the surface of the wound.
Additional amounts used to fill a cavity are not medically necessary. Documentation must substantiate the medical
necessity for code A6248 billed in excess of 3 units (fluid ounces) per wound in 30 days.
Use of more than one type of hydrogel dressing (filler, cover, or impregnated gauze) on the same wound at the same
time is not reasonable and necessary.
SPECIALTY ABSORPTIVE DRESSING (A6251-A6256):
Specialty absorptive dressings are covered when used for moderately or highly exudative wounds (e.g., stage III or IV
ulcers). Usual specialty absorptive dressing change is up to once per day for a dressing without an adhesive border and
up to every other day for a dressing with a border.
TRANSPARENT FILM (A6257-A6259):
Transparent film dressings are covered when used on open partial thickness wounds with minimal exudate or closed
wounds. Usual dressing change is up to 3 times per week.
WOUND FILLER, NOT ELSEWHERE CLASSIFIED (A6261-A6262):
Usual dressing change is up to once per day.
WOUND POUCH (A6154):
Usual dressing change is up to 3 times per week.
TAPE (A4450,A4452):
Tape is covered when needed to hold on a wound cover, elastic roll gauze or non-elastic roll gauze. Additional tape is
usually not required when a wound cover with an adhesive border is used. The medical necessity for tape in these
situations must be documented. Tape change is determined by the frequency of change of the wound cover. Quantities
of tape submitted must reasonably reflect the size of the wound cover being secured. Usual use for wound covers
measuring 16 square inches or less is up to 2 units per dressing change; for wound covers measuring 16 to 48 square
inches, up to 3 units per dressing change; for wound covers measuring greater than 48 square inches, up to 4 units per
dressing change.
LIGHT COMPRESSION BANDAGE (A6448-A6450), MODERATE/HIGH COMPRESSION BANDAGE (A6451, A6452),SELF-ADHERENT BANDAGE (A6453-A6455), CONFORMING BANDAGE (A6442-A6447), PADDING BANDAGE (A6441):
Most compression bandages are reusable. Usual frequency of replacement would be no more than one per week unless
they are part of a multi-layer compression bandage system.
Conforming bandage dressing change is determined by the frequency of change of the selected underlying dressing.
GRADIENT COMPRESSION WRAP (A6545):
Coverage of a non-elastic gradient compression wrap (A6545) is limited to one per 6 months per leg. Quantities
exceeding this amount will be denied as not reasonable or necessary. Refer to Policy Article for statement concerning
noncoverage if the ulcer has healed.
Documentations Requirements
Section 1833(e) of the Social Security Act precludes payment to any provider of services unless "there
has been furnished such information as may be necessary in order to determine the amounts due such
provider." It is expected that the patient's medical records will reflect the need for the care provided. The
patient's medical records include the physician's office records, hospital records, nursing home records,
home health agency records, records from other healthcare professionals and test reports. This
documentation must be available upon request.
An order for each item billed must be signed and dated by the treating physician, kept on file by the
supplier, and made available upon request. Items billed before a signed and dated order has been
received by the supplier must be submitted with an EY modifier added to each affected HCPCS code.
The order must specify (a) the type of dressing (e.g., hydrocolloid wound cover, hydrogel wound filler,
etc.), (b) the size of the dressing (if appropriate), (c) the number/amount to be used at one time (if
more than one), (d) the frequency of dressing change, and (e) the expected duration of need.
A new order is needed if a new dressing is added or if the quantity of an existing dressing to be used is
increased. A new order is not routinely needed if the quantity of dressings used is decreased. However a
new order is required at least every 3 months for each dressing being used even if the quantity used has
remained the same or decreased.
Information defining the number of surgical/debrided wounds being treated with a dressing, the reason
for dressing use (e.g., surgical wound, debrided wound, etc.), and whether the dressing is being used as
a primary or secondary dressing or for some noncovered use (e.g., wound cleansing) must be obtained
from the physician, nursing home, or home care nurse. The source of that information and date obtained
must be documented in the supplier's records.
Current clinical information which supports the reasonableness and necessity of the type and quantity of
surgical dressings provided must be present in the patient's medical records. Evaluation of a patient's
wound(s) must be performed at least on a monthly basis unless there is documentation in the medical
record which justifies why an evaluation could not be done within this timeframe and what other
monitoring methods were used to evaluate the patient's need for dressings. Evaluation is expected on a
more frequent basis (e.g., weekly) in patients in a nursing facility or in patients with heavily draining or
infected wounds. The evaluation may be performed by a nurse, physician or other health care
professional. This evaluation must include the type of each wound (e.g., surgical wound, pressure ulcer,
burn, etc), its location, its size (length x width in cm.) and depth, the amount of drainage, and any other
relevant information. This information must be available upon request.
When surgical dressings are billed, the appropriate modifier (A1 – A9, AW, EY, or GY) must be added to
the code when applicable. If A9 is used, information must be submitted with the claim indicating the
number of wounds. If GY is used, a brief description of the reason for non-coverage (e.g., "A6216GY -
used for wound cleansing") must be entered in the narrative field of the electronic claim.
When codes A4649, A6261 or A6262 are billed, the claim must include a narrative description of the item
(including size of the product provided), the manufacturer, the brand name or number, and information
justifying the medical necessity for the item. This information must be entered in the narrative field of
the electronic claim.
Refer to the Supplier Manual for more information on documentation requirements.
RefillsFor more information on local coverage determination Local Coverage Determination (LCD) for Wound Care / Surgical Supplies
