Medicare Part B Wound Care Coverage Guide

Yes, Medicare Part B covers mobile wound care visits when you are homebound or have difficulty traveling to a clinic. The provider must document that in-home visits are medically necessary and that you have mobility limitations. Coverage includes wound assessment, treatment, debridement, and dressing changes performed in your home.

The 2024 Medicare Part B deductible is $240 per year. Once you meet this deductible, Medicare pays 80% of the approved amount for wound care services, and you pay 20%. If you have a Medigap (Medicare Supplement) plan, it typically covers the 20% coinsurance, meaning you pay $0 out-of-pocket after your deductible.

Yes, Medicare Part B covers amniotic membrane grafts and other cellular/tissue-based products (CTPs) for chronic wounds that haven't healed after 30 days of standard care. Coverage requires proper documentation showing medical necessity, failed conventional treatments, and appropriate wound size criteria. The provider must use a Medicare-approved product with proper coding.

Medicare doesn't set a specific limit on the number of wound care visits per month. Coverage depends on medical necessity—if your wound requires weekly or bi-weekly visits for debridement, dressing changes, or monitoring, Medicare will cover them as long as they're properly documented. Typical coverage ranges from 1-4 visits per month depending on wound severity and treatment needs.

Absolutely. Medicare Part B fully covers wound care for diabetic foot ulcers, including specialized treatments like debridement, offloading devices, negative pressure therapy, and skin substitutes. Diabetic wound care is considered medically necessary due to the high risk of infection and amputation. Medicare also covers therapeutic shoes and orthotics for diabetic patients with neuropathy.

If Medicare denies a claim, you have the right to appeal. Most denials are due to insufficient documentation, not because the service isn't covered. Healix360 providers handle appeals on your behalf, submitting additional documentation and medical records to overturn denials. You won't be billed for services while an appeal is pending unless Medicare issues a final denial after exhausting all appeal levels.

With Original Medicare (Parts A and B), you do NOT need a referral to see a wound care specialist. You can self-refer or be referred by your primary care physician. However, some Medicare Advantage plans may require referrals, so check your specific plan requirements. Healix360 can help verify your plan's rules during the eligibility check.

Yes, Medicare Part B covers wound care supplies when they're provided as part of your treatment by a healthcare professional. This includes advanced dressings applied during visits. However, supplies for self-care at home between visits may require prior authorization or may be covered under Part B Durable Medical Equipment (DME) benefits with different cost-sharing rules.

Medicare Part B (Original Medicare) covers 80% of wound care after your deductible, with no network restrictions. Medicare Advantage plans must cover everything Part B covers but may have different cost-sharing, require prior authorization, or limit you to in-network providers. Many Medicare Advantage plans also offer additional benefits like lower copays or coverage for services Part B doesn't cover.

Medicare covers wound care for as long as it's medically necessary and the wound is showing improvement or requires ongoing management. There's no time limit on coverage. Even chronic wounds that take months to heal remain covered as long as documentation shows the treatment is working or that alternative approaches are being attempted. Coverage continues until the wound fully heals or reaches maximum medical improvement.