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Medicare Coverage for Wound Care and Supplies

Medicare will cover wound care for all beneficiaries, regardless if it’s done in an inpatient or outpatient setting. Wound care can end up being extremely expensive. As we age, we’re more susceptible to injuries or wounds. Some people suffer from post-surgical lesions. Others may suffer from chronic fungal or viral wounds. Because of the prevalence of wounds with age, it’s easy to see why Medicare would cover this treatment. Below, we’ll go over what you need to know about Medicare coverage for wound care.

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Medicare Guidelines for Wound Care

Medicare will cover treatment for surgical wounds. Also, Medicare covers chronic wounds; you may end up getting. Medicare covers wound care supplies for many different types of wounds. Some of the lesions may be from surgeries, ulcers, burns, or flesh wounds. Depending on if you receive wound care as an inpatient or outpatient will determine which part of Medicare will cover the cost.

Inpatient Wound Care Coverage Under Medicare

If you receive wound care in inpatient settings like a hospital, rehab facility, or Skilled Nursing Facility, coverage would fall under Medicare Part A. There is a deductible under Part A. Most Medicare Supplement plans will cover this deductible.

Outpatient Wound Care Coverage Under Medicare

If you receive wound care in an outpatient setting, such as at your doctor’s office, coverage would fall under Medicare Part B. Part B also covers Durable Medical Equipment. This includes any supplies that are medically necessary to treat your wound. Just like Medicare Part A, Part B also comes with a deductible. However, if you have a supplemental plan, it could be covered.

Wound Care Supplies Covered by Medicare

Medicare will cover primary and secondary wound dressings for your injuries. Primary dressings apply directly to your injury, and secondary forms of dressings are like aids to the primary dressings. Secondary dressings are bandages, gauze, and adhesive tape.

  • Hydrogel Dressings
  • Hydrocolloid Dressings
  • Gauze
  • Foam Dressings
  • Alginate Dressings

Medicare Documentation Requirements for Wound Care

Your doctor will need to provide documentation that your wound is still present. Medicare only covers wound treatment if you have the necessary documents.

  • Evidence of your wound
  • Size of your wound
  • The extent of damage your injury is causing
  • Any necessary drainage needs

Medicare Advantage Coverage for Wound Care

With a Medicare Advantage plan, cost-sharing is dependent on the carrier. It’s extremely difficult to predict how much you’ll pay out of pocket with a Medicare Advantage plan. You would want to contact the carrier directly to find out how much they will cover and what your cost-sharing will be.

Medicare Supplement Coverage for Wound Care

Cost-sharing is predictable when it comes to Medicare Supplements. As long as Medicare Part A & Part B pays, your Medigap plan will pay all or most of the remaining costs. If you have Medicare Supplement Plan F, you will pay zero out of pocket. If you have Plan G, you’ll only pay the Part B deductible.

FAQs

Does Medicare pay for wound care in a skilled nursing facility?
You can receive necessary wound care in a skilled nursing facility if you qualify. When you stay in a nursing facility, the treatment falls under your Part A benefits.
Will wound care supplies be considered Durable Medical Equipment?
Yes, you’ll be able to get wound care supplies form a Durable Medical Equipment supplier.
Which wound care supplies does Part B cover?
Part B will cover several different forms of wound dressings. For example, Medicare will cover hydrogel dressings, hydrocolloid dressings, gauze, foam dressings, and alginate dressings.
Does Medicare cover InterDry?
InterDry is a protectant for your skin. It helps manage your skin folds and can help keep your skin dry. Since InterDry is a single-use wound care item, Medicare won’t cover it.
Does Medicare cover in-home wound care?
Yes, but Medicare will only cover intermittent nursing services. Skilled nursing care could include in-home wound dressings.
Does Medicare cover a wound vac?
Yes, a wound vac wound falls under Part B.
Does Medicare cover negative pressure wound therapy?
NPWT is when sub-atmospheric pressure is applied to your wound. This application removed exudate and debris. It can be done through a suction pump, dressing sets, or a separate exudate collection chamber. As long as your doctor has a record of other treatments tried, Medicare will cover NPWT.

How to Get Help with Your Wound Care Costs Under Medicare

Medicare may cover many of the wound care services you need, but certainly not all. Medigap can help cover the deductibles and coinsurances you’d otherwise pay. To find Medicare Supplement plans in your area, call our team of agents at the number above. We can identify the most affordable policy in your area. If you can’t call now, fill out an online rate form and compare plans in your area!

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Negative Pressure Wound Therapy Pumps, CMS. Accessed October 2023.
    https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33821
Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare educator serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

33 thoughts on "Medicare Coverage for Wound Care and Supplies"

  1. My dad needs his wound bandage changed daily as instructed by his Doctor. He is at home and Medicare says they will only pay for 3 days a week. If the doctor says it needs to be changed daily why won’t Medicare pay? He has Medicare Part A + B

    1. Hi Diane. Unfortunately, Medicare and CMS have deemed 3 bandage changes a week necessary so physicians must abide by this.

  2. Hello
    My question is my wife had surgery back in december,,she has a surgical wound under her belly that they have been doing a wet to dry bandage, then she has had a wound vac for a few weeks now is back to wet to dry dressing, it’s suppose to be changed twice a day, the vna is saying it isn’t covered ,,this was the doctors orders, ,, Could you please help me figure this out

    1. Peter, if the order came from a VA doctor at a VA facility, only VA coverage will be able to cover this. However, if the order came from a civilian doctor, it might be covered by Medicare.

    1. Ellie, yes! Medicare will cover medically necessary wound care in a skilled nursing facility. This is covered in both the outpatient and inpatient setting.

  3. Hi.
    My 89 year old Mom has to go to the wound center once a week but the doctor needs her to change the bandage everyday. I have to change it for her . We are looking into a nurse for a few times a week. Question is if I need to buy her the roll goes and these silicone sponge dressing how does she get reimbursed for it or do we order it through Medicare. ? I know you say it can be covered but what are they logistics of actually getting that covered. Thank you!!

    1. Hi Anna! This is a little out of my wheelhouse but I would think you would need to order the supplies through a Medicare-approved DME provider. CMS has a great tool for finding a DME provider near you. I would confirm this with your doctor, they may know something I don’t in regards to reimbursement for the supplies.

    1. Hi Nancy! As long as it’s built into the patients’ treatment plan that was sent to Medicare, it will be covered.

    1. Hi Sarah! That is correct. You cannot bill Medicare for DME that the patient brought from home.

  4. Hi Lindsay,

    I am a Registered Nurse working in home health. Does Medicare cover ongoing twice a day wound care in the home?

    1. Hi Barb! Yes, as long as it’s built into her treatment plan that her doctor created and sent to Medicare, it will be covered.

  5. My husband has bullous pemphigoid skin disease. Initially, it was really bad big blisters all around his stoma. Finally, it healed but in order to not have recurrence, we Must use a specific brand of silicone foam dressings. Is there any way to get Medicare to cover these dressing as a preventive measure based on this d iui diagnosis. It was SO bad the dr. was discussing tubes coming out of his kidneys the rest of his life.

    1. Hi Sue! If your doctor deems these silicone foam dressings medically necessary, then I would think they would be considered durable medical equipment and coverage would fall under Part B. Your doctor may be able to provide better insight or the manufacture that makes these dressings.

  6. Can a person go to skilled nursing facility and a hospital based outpatient wound clinic? Would the faculty be responsible for payment from what Medicare pays the facility?

    1. Hi Linda! As long as both facilities are Medicare-approved facilities, they can bill Medicare for the Medicare-approved amount for those services.

  7. Hi! Will Medicare cover an EZBra? It’s a very specific product that may be the only one my mother can usr for advanced breast cancer.
    Thank you!

  8. Will Medicare cover a wound dressing when applied to a surgical wound that has sutures? The dressing would be applied over the sutures. If so, are measurements required for the sutured surgical wound? Thanks so much

    1. Hi Sheryl! Yes, Medicare will cover a wound dressing that’s applied over sutures. I don’t believe there are measurement requirements for this. However, I would contact Medicare directly to make sure.

  9. Hi Lindsay
    I’m trying to understand more about wound dressings that contain or are impregnated with a drug. Are they reimbursed as supplies (e.g., HCPC A-codes) or drugs (HCPCS J-codes) or some other HCPCS (e.g., Q code) or CPT code (procedure code)? This is a very confusing space and I’m trying to help someone understand this drug/device combination space. Also can you clarify that in order for Medicare to pay for these wound care services they have to be administered in a facility (inpatient, outpatient, physician office, clinic, SNF, etc. Could a patient (with a physician prescription) get these supplies delivered to their home under a DME benefit and administer to themselves? Thanks and great info above so far.

    1. Hi Greg! The medicated wound dressings, such as antimicrobial foam dressings, would fall under DME and be billed under Part B as supplies. Yes, in order for Medicare to cover the costs of the dressings they would need to be administered in a facility. Wound Management & Prevention has a great article on this topic that may provide more insight for you.

  10. Hi Lindsay,

    My name is Keith Walsh and I need wound gel dressings for my wounds. I have been treated by an arterial and vascular doctors. I have been battling with foot ulcers for 12 years. I need Medicare to cover my supplies. My doctors recommend that I get my dressings from Dollar Tree. Why? Is there a way I can just order online through my Medicare? What companies provide supplies that cover the full cost?

    1. Hi Keith! Unfortunately, Medicare will only cover wound care dressings & supplies when administered in an inpatient or outpatient setting. The only time they will cover wound dressings at home is if it’s given by a licensed or certified nurse.

  11. Thank you Lindsay. I have done wound care for a little over 30 years now and the products that we are prescribing are hydrocolloids, foams, silver gels so after reviewing the list of what isn’t covered I am guessing these agencies are just trying to save a buck. I really don’t understand why medicare would not pay for a wound cleanser when that is a total requirement for the wound to be cleansed with each dressing change. Thank you again.

    1. Honestly, I would call Medicare and maybe talk to others in your industry doing the same thing. It’s all about the CPT codes. Maybe the above products mentioned fall under a different CPT code and bundled. Just a thought! It’s very hard for me to know for sure since there are so many different factors and variations. A good Medicare representative may be able to tell you what those would fall under for this type of service. I say “good” representative because we’ve come across many who are not as educated on the topic as you would think they should be. If you don’t feel the answer you got was correct, call again to speak to someone else.

  12. I am a Nurse Practitioner who owns a wound care company and does E/M & goes out only to see home care patients after the consult is placed by PCP. Can you tell me where it states in Medicare guidelines that wound care products are covered under their home health visit? Patients are being told that the home health agency does not have to supply the dressings.

    1. Medicare pays in full for certain medical supplies, such as wound dressings and catheters, when provided by a Medicare-certified home health agency. The home health agency would bill Medicare under Part B for the supplies used during the visit. Here is a list of wound care supplies that are not covered by Medicare.

  13. Yes it is helpful, but how many days will Medicare pay for an in home nursing care for a wound. I have been told that the dressing needs to be changed 2x a day.

    1. As long as the care given is through a Medicare-certified home health agency, Medicare will pay the full cost for up to 60 days. After 60 days, Medicare will review your plan of care with your doctor to determine if care should be continued or not.

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