Surgical Dressings Questions & Answers (Q&As)
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- How do I use the A1-A9 modifiers? Does each dressing on the claim need a separate A1-A9 modifier depending on how many wounds each dressing is being used for, or the total number of wounds?
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Modifiers A1 – A9 have been established to indicate that a particular item is being used as a primary or secondary dressing on a surgical or debrided wound, and to indicate the number of wounds on which that dressing is being used. The modifier number must correspond to the number of wounds on which the dressing is being used, not the total number of wounds treated. For example, if the beneficiary has four (4) wounds but a particular dressing is only used on two (2) of them, the A2 modifier must be used with that HCPCS code.
Originally published: 01.08.2020
Revised: 12.30.2024
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- I have submitted a claim for one impregnated gauze dressing and it keeps getting denied. But another impregnated gauze dressing has been paid with no problem. Why would one be paid and the other not?
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There could be several possible reasons for denial of one and not the other.
The surgical dressings policy specifies substances or agents incorporated into dressings that are deemed impregnated gauze dressings that may qualify for coverage (when other policy and statutory requirements are met). Gauze, when impregnated with anything other than water, normal saline, hydrogel, or zinc paste (A6222-A6224, A6266), is covered under the surgical dressings benefit, while gauze impregnated with water or normal saline (A6228-A6230) is denied as not reasonable and necessary, because there is no medical necessity for these compared to non-impregnated gauze moistened with bulk saline or sterile water.
Keep in mind that dressings which contain substances not recognized as effective dressing materials (such as honey or silver) may result in denial. There are also some impregnated dressings which are not covered as surgical dressings because they are impregnated with a drug listed in the FDA’s Orange Book. This type of dressing (e.g. antibiotics which require a prescription) would not be covered as a surgical dressing, but as a drug.
Originally published: 01.08.2020
Revised: 12.30.2024
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- We have a patient whose wounds are being managed by their primary care physician. She is wheelchair bound and her provider's office is not able to facilitate transfer. Due to this she cannot have all of her wounds evaluated by her provider. Her spouse is able to measure the wounds at home and they then discuss the wounds when she sees her provider. Does this reflect a situation in which "other monitoring methods" are being appropriately used to evaluate ongoing need for dressing supplies?
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Evaluation of the beneficiary's wounds must be performed by a qualified health care professional (such as a nurse or treating practitioner) involved in the regular care of the beneficiary. If there is documentation in the beneficiary's medical records which justifies why such an evaluation could not be completed within the specified timeframe and which documents the other monitoring methods implemented to evaluate the beneficiary's need for ongoing utilization of dressings, evaluation of the wounds performed by the beneficiary's spouse does meet this requirement.
Originally published: 01.08.2020
Revised: 12.30.2024
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- What are the required elements of a wound evaluation?
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It depends on whether it is an initial wound evaluation or an ongoing evaluation to support continued use/need of a particular dressing and quantity dispensed.
An initial evaluation must include:
- The type of dressing (hydrocolloid wound cover, hydrogel wound filler, etc.)
- The number/amount to be used at one time (if more than one)
- The frequency of dressing change
- An ongoing evaluation for continued use/need should include:
- The type of each wound (surgical wound, pressure ulcer, burn, etc.)
- Wound(s) location
- Wound size (length x width) and depth
- Amount of drainage
- Any other relevant wound status information
Originally published: 01.08.2020
Revised: 12.30.2024
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- What dressing would I use for pressure ulcers?
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Surgical dressings are covered when a qualifying wound is present. A qualifying wound is defined as either a wound caused by, or treated by, a surgical procedure; or after the debridement of the wound, regardless of the debridement technique. Therefore, unless a pressure ulcer has been treated by a surgical procedure or has been debrided, pressure ulcers are never covered under the surgical dressing benefit.
Originally published: 01.08.2020
Revised: 12.30.2024
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- What kind of situation would warrant the medical need for using alginate as primary and secondary?
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It is acceptable to use 2 alginate dressings together (primary and secondary) for a wound with moderate to heavy exudate.
Originally published: 02.17.2021
Revised: 12.30.2024
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- Can a secondary wound cover be billed only in conjunction with a primary wound cover? For example, if a primary wound dressing is not billable due to containing silver or honey, is the secondary not billable as well?
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Medicare limits reimbursement to items that have sufficient clinical evidence to demonstrate that use of the item is safe and effective. Materials including Balsam of Peru in castor oil, iodine (other than iodoform gauze packing); carbon fiber; charcoal, copper; honey, and silver that lack sufficient clinical evidence are not recognized as effective and are not considered reasonable and necessary.
If the primary dressing contains any of the materials listed above as the predominant component (greater than 50% by weight), the primary and secondary dressing on that wound will not be covered.
Originally published: 02.17.2021
Revised: 05.23.2025
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- We have a practitioner prescribing a debriding agent applied to a primary dressing every day, and then a foam secondary cover that has a frequency of up to 3x/week. Should we tell the doctor that he needs to order a different secondary with a frequency of 1x/day?
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The Surgical Dressings Local Coverage Determination (LCD) states: "The frequency of recommended dressing changes depends on the type and use of the surgical dressing. When combinations of primary dressings, secondary dressings, and wound filler are used, the change frequencies of the individual products should be similar. For purposes of this policy, the product in contact with the wound determines the change frequency. It is not reasonable and necessary to use a combination of products with differing change intervals. For example, it is not reasonable and necessary to use a secondary dressing with a weekly change frequency over a primary dressing with a daily change interval. Such claims will be denied as not reasonable and necessary."
Originally published: 02.17.2021
Revised: 12.30.2024
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- Some patients who use negative pressure wound therapy (NPWT) durable medical equipment canisters or dressings may need a primary surgical dressing underneath the NPWT dressing. If the surgical dressing meets all the surgical dressing policy requirements, and if the NPWT meets all the NPWT policy requirements, will Medicare cover and pay for both the NPWT dressings and the primary surgical dressing ordered by the practitioner?
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No, NPWT is not designed for use with a separate primary dressing. The purported efficacy of NPWT is, in part, related to the direct contact of the NPWT dressing with the wound bed. Code A6550 describes an allowance for a dressing set which is used in conjunction with a stationary or portable NPWT pump (E2402). A single code A6550 is used for each single, complete dressing change, and contains all necessary components, including but not limited to any separate, non-adherent porous dressing(s), drainage tubing, and an occlusive dressing(s) which creates a seal around the wound site for maintaining sub-atmospheric pressure at the wound.
Originally published: 02.17.2021
Revised: 12.30.2024
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