Reimbursement of Wound Care Products

Collagen advanced wound care dressings are reimbursed by Medicare Part B, Medicaid, HMO’s, and other primary payors. Following Medicare Part B and third-party payer guidelines are critical in paid reimbursement claims. Medicare Part B will generally pay 80% of the Medicare-approved amount after paid deductible. Third-party payers can vary by State, plan type, and Provider.

Reimbursement Guidelines

Purpose:

To deliver evidence-based advanced wound care while utilizing established and developed medical standards to optimize wound healing outcomes:

  • Weekly wound assessment should include:

    1. Wound location
    2. Wound type – pressure, diabetic, venous, arterial, surgical, trauma, other.
    3. Depth of tissue involvement – partial-thickness, full-thickness, undermining, tunneling, exposed structure.
    4. Exudate amount – scant, minimal, moderate, heavy, copious
    5. Exudate consistency – color, odor
    6. Wound bed tissue type(s) or color(s)
    7. Periwound, wound edges, and surrounding skin
    8. Pain level – location, duration, frequency
  • Use appropriate primary dressing, collagen formulation (KollagenTM particles, sheet, or gel) based on wound assessment.
  • Secondary dressings are used as a cover dressing: e.g., transparent, gauze, abdominal pad, foam, super-absorbent pad, hydrocolloid, Unna's boot, and multi-layer wrap. 
  • Dressing size is determined by wound measurements that may or may not include periwound. A larger dressing may be used if the clinical rationale supports product size.
  • Physician progress note/wound note must substantiate advanced wound care products and frequency of change.
  • Wound photos can be used as an adjunct to written documentation.  Always follow your policy and procedures.
  • Physician detailed written order must be signed and dated for each product billed, including # of dressings and directions for us. Orders may be placed every 30 days per Medicare Part B guidelines.
  • The physician will monitor wound progress and treatment plan weekly and make changes to treatments as appropriate if no wound healing progress >2 weeks.

Reference:CMS Medicare Coverage Database Details. https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33831&ContrID=140

Disclaimer: The information provided with this notice is general reimbursement information only. It is not legal advice, nor is it advice about how to code or submit any claim for payment. It is always the provider's responsibility to determine and submit appropriate codes, charges, modifiers, and bills for services rendered. The coding and reimbursement information is subject to change without notice. Before filing any claims, providers should verify current requirements and policies with the payer..


Medifil® II

Available Size: 1gm Vials and 1gm Pouches

HCPCS Code: A6010

SkinTemp® II

Available Size: 2”x2”, 3”x4”, and 8”x12” Sheets

HCPCS Code: A6021/A6022/A6023

Collatek®

Available Size: 30gm/1oz Tubes

HCPCS Code: A6011