S9097 — Home visit for wound care
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Key Coverage Criteria
- Note:To be eligible for wound care in the home setting, the individual must be confined to the home as defined in CG-MED-23 Home Health.
- Initial care for a chronic wound in the home or outpatient setting is consideredmedically necessarywhen:
- The wound care is prescribed by the attending physician, health care provider practicing within the scope of license, or the primary care physician in coordination with the attending physician as part of a written plan of care;and
- The wound care is so inherently complex that it can only be safely and effectively performed by or under the general supervision of a licensed medical professional (for example, but not limited to stage III or IV pressure ulcers, non-healing neuropathic ulcers, venous or arterial insufficiency related ulcers, persistent wounds);and
- A complete, individualized wound care program appropriate to the type of wound being treated, which meetsallof the requirements below, has been initiated:Initial documentation in the individualâs medical record of evaluation, plan of care, wound care, wound characteristics, and wound measurements by a licensed medical professional;andApplication of dressings according to manufacturer guidelines;andDebridement of necrotic tissue if present;andEvaluation of and provision for adequate nutritional [...]
- Initial documentation in the individualâs medical record of evaluation, plan of care, wound care, wound characteristics, and wound measurements by a licensed medical professional;and
2 Active Policies
ANTHEM-CG-MED-71 — CG-MED-71 Chronic Wound Care in the Home or Outpatient Setting
ANTHEM-CG-MED-23 — CG-MED-23 Home Health
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.