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Q&A: Wound Care Supplies NOT Covered by Medicare

Posted on in Product and Service Solutions

By Heather Trumm, Director of VGM Wound Care

Hello, fellow HME wound care members! Being in the wound care space, we have so many rules and regulations we need to keep straight. 

I’ve received these questions a few times recently, so I thought it would be a good time to review.

Q: What wound care supplies doesn’t Medicare cover, and what can I do when my customer wants these supplies? 

A: According to CMS.gov, the following wound care supplies are not covered under Medicare part B DMEPOS. They are noncovered under the surgical dressing benefit because they do not meet the statutory definition of a dressing (not all-inclusive). 
If your customer requests any of these items, they need to pay cash for them. 

  • Skin sealants or barriers (A6250)
  • Wound cleansers (A6260) or irrigating solutions
  • Solutions used to moisten gauze (e.g., saline)
  • Silicone gel sheets (A6025)
  • Topical antiseptics
  • 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 bandage (A6413)
  • Any item listed in the latest edition of the Orange Book (e.g., an antibiotic-impregnated dressing) which requires a prescription
  • Gradient compression stockings (A6530, A6533-A6544, A6549)
  • Surgical stockings (A4490-A4510)
  • Non-elastic binder for an extremity (A4465)
  • Small adhesive bandages (e.g., Band-Aid or similar product) not primarily used for the treatment of wounds addressed in the Surgical Dressings policy

These dressings are noncovered under the surgical dressing benefit.

If you have a question about wound care products, Medicare coverages, etc., or if you an idea for a blog topic, contact me directly by phone at 319-493-8523 or via email at [email protected]. We would love to cover topics that you want to know more about! 

If you’re not yet a member of the VGM Wound Care program and would like to know more about the benefits of membership, complete the form on our website.