Surgical dressings are limited to primary and secondary dressings required for the treatment of a wound caused by, or treated by, a surgical procedure that has been performed by a physician or other health care professional to the extent permissible under State law.
Surgical dressings required after debridement of a wound are also covered, irrespective of the type of debridement, as long as the debridement was reasonable and necessary and was performed by a health care professional acting within the scope of his/her legal authority when performing this function.
Surgical dressings are covered for as long as they are medically necessary.
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 dressing materials that serve as therapeutic or protective function and that are needed to secure a primary dressing are also covered. Example – adhesive tape, roll gauze, bandages, and disposable compression material)
- Drainage from a cutaneous fistula which has not been caused by or treated by a surgical procedure;or
- Stage I pressure ulcer;or
- First degree burn;or
- Wounds caused by trauma which do not require surgical closure or debridement – e.g., skin tear or abrasion;or
- A venipuncture or arterial puncture site (e.g., blood sample) other than the site of an indwelling catheter or needle.
NOT ORDINARILY COVERED as surgical dressings: elastic stockings, support hose, foot coverings, leotards, knee supports, surgical leggings, gauntlets, and pressure garments for the arms and hands
COVERED.For a beneficiary to be eligible for surgical dressing reimbursement at least one of the two following key statutory requirements must be met:
- The wound must be surgically-created or surgically modified;OR
- The wound requires debridement
- Must contain sufficient information regard the wound(s) – etiology, size, depth, tunneling/undermining, exudate/escar characteristic, prior treatments.