Does Medicare cover wound care and surgical dressings?

What wound care does Medicare cover?

Medicare Part B covers surgical dressing services, which are the medically necessary treatment of a surgical or surgically treated wound. Medicare pays for the dressings themselves under its Surgical Dressings Benefit. Local Coverage Determination L33831, the local policy Medicare's durable medical equipment contractors use for surgical dressings, says this benefit only covers primary and secondary surgical dressings used on the skin on specified wound types:

• Primary dressings are therapeutic or protective coverings applied directly to wounds or lesions, either on the skin or caused by an opening to the skin.
• Secondary dressings are materials that serve a therapeutic or protective function and are needed to secure a primary dressing, like adhesive tape, roll gauze, bandages and disposable compression material.

Which wounds qualify for Medicare-covered dressings?

Under that local policy, surgical dressings are covered when a qualifying wound is present. Its policy article (A54563) defines a qualifying wound as a wound caused by, or treated by, a surgical procedure, or a wound after debridement, regardless of the debridement technique. A treating practitioner or other health care professional must perform the surgery or debridement, to the extent state law allows. The article gives these examples of situations where dressings aren't covered under the Surgical Dressings Benefit:

• Drainage from a cutaneous fistula that wasn't caused by or treated by a surgical procedure
• A Stage 1 pressure ulcer
• A first degree burn
• Wounds caused by trauma that don't require surgical closure or debridement, like a skin tear or abrasion
• A venipuncture or arterial puncture site (like where blood was drawn), other than the site of an indwelling catheter or needle

What do I pay for wound care?

After you meet the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount for your doctor's or other health care provider's services. You also pay a separate copayment for these services when you get them in a hospital outpatient setting.

Under the local policy, if your treating practitioner applies dressings as part of a professional service billed to Medicare, the dressings are part of that service and aren't billed separately. Dressings sent home with you for later dressing changes can be billed by the supplier, and the supplier must have a written order from your treating practitioner before it bills Medicare. A new order is needed every 3 months for each dressing you use, and when a new dressing is added or the quantity is increased.

Does Medicare cover wound care at home?

Yes, through home health care if you qualify. Medicare-covered home health services include medically necessary part-time or intermittent skilled nursing care, like wound care for pressure sores or a surgical wound, and medical supplies for use at home. A doctor or other health care provider must see you in person, confirm you need home health care and order it, and a Medicare-certified home health agency must provide it. You must need part-time or intermittent skilled services and be homebound, which means you must meet both of these conditions:

• Leaving your home isn't recommended because of your condition, or you have trouble leaving your home without help (like using a cane, wheelchair, walker or crutches; special transportation; or help from another person) because of an illness or injury.
• You're normally unable to leave your home, and leaving takes a lot of effort.

What wound care products aren't covered as dressings?

The local policy article lists these wound care items, among others, as not covered under the Surgical Dressings Benefit because they don't meet the definition of a dressing. Gradient compression stockings aren't covered as dressings either, but they may be considered under Medicare's lymphedema compression treatment benefit; see how Medicare covers compression stockings.

• Skin sealants or barriers
• Wound cleansers or irrigating solutions
• Solutions used to moisten gauze, like saline
• Silicone gel sheets
• Topical antiseptics and topical antibiotics
• Enzymatic debriding agents
• Gauze or other dressings used to cleanse or debride a wound but not left on the wound
• First-aid type adhesive bandages
• Surgical stockings

Does Medicare cover hyperbaric oxygen therapy for wounds?

Medicare Part B may cover hyperbaric oxygen therapy in a chamber if you have one of the conditions Medicare lists, which include gas gangrene, progressive necrotizing infections, preparation and preservation of compromised skin grafts, and diabetic wounds of the lower extremities. For diabetic wounds of the lower extremities, all of these must apply: you have Type 1 or Type 2 diabetes and a lower extremity wound that's due to diabetes, the wound is classified as Wagner grade III or higher, and you've failed an adequate course of standard wound therapy. You usually pay 20% of the Medicare-approved amount, and the Part B deductible may apply. See Medicare's hyperbaric oxygen therapy rules.