Medicare and insurance coverage for wound dressings, biologics, NPWT supplies, and medical equipment.
Wound care supplies fall into two Medicare categories: (1) Supplies provided during professional visits covered under Part B as part of the service, and (2) Durable Medical Equipment (DME) for home use covered under Part B DME benefits. Understanding this distinction is critical because coverage rules and cost-sharing differ significantly between the two categories.
Professional-applied supplies (dressings changed by nurse during visit) = Part B professional services. Patient self-care supplies (dressings you change at home between visits) = Part B DME benefits with different authorization and suppliers.
All dressings applied by your wound care provider during visits are covered: collagen dressings, alginate dressings, foam dressings, hydrogel dressings, antimicrobial dressings (silver, iodine, honey), composite dressings, hydrocolloid dressings, and transparent films. These are billed as part of the wound care visit.
Your cost: 20% coinsurance after Part B deductible (covered by Medigap if you have it)
Skin substitutes, amniotic membrane grafts, bioengineered tissues, and acellular dermal matrices applied during treatment. Requires documentation of medical necessity and failed conventional treatment for at least 30 days.
Your cost: 20% coinsurance (typically $200-500 per application)
Scalpels, scissors, curettes, forceps, and other instruments used during sharp debridement. Included in the debridement procedure code—no separate charge to patient.
Your cost: Included in 20% visit coinsurance
Pump rental, foam dressings, canisters, tubing, and adhesive drapes. Medicare covers as monthly DME rental. Requires prior authorization with comprehensive documentation. Covered for qualifying wounds (Stage III/IV pressure ulcers, dehisced surgical wounds, certain diabetic ulcers).
Your cost: 20% of monthly rental fee (typically $100-160/month)
One pair of extra-depth therapeutic shoes and three pairs of custom-molded inserts annually for diabetic patients with neuropathy, history of foot ulcers, foot deformity, or amputation. Shoes must be prescribed by physician and fitted by qualified professional (pedorthist).
Your cost: 20% coinsurance (often $0 with Medigap)
CAM walker boots, total contact casts, knee scooters, crutches, and wheelchairs when medically necessary for offloading diabetic foot ulcers. Prescription required with diagnosis and medical necessity documentation.
Your cost: 20% coinsurance for purchase or rental
Compression stockings (20-30 mmHg or higher), multi-layer compression systems, and compression pumps for venous insufficiency and lymphedema. Requires documented venous disease and failed conservative treatment.
Your cost: 20% coinsurance (stockings may need annual replacement)
Over-the-counter supplies (gauze, tape, Band-Aids purchased at pharmacy), wound cleansers and saline for home use, ointments and creams not prescribed as part of treatment, comfort items (wound pillows, special sheets), and supplies for non-covered cosmetic treatments. Basic wound care supplies between professional visits are typically patient responsibility unless ordered as DME.