CG-MED-71 Chronic Wound Care in the Home or Outpatient Setting

CG-MED-71 addresses skilled chronic wound care delivered in the home or outpatient setting. Coverage is medically necessary when care is ordered under a written plan by the attending/PCP, the wound is complex enough to require performance by or under the general supervision of a licensed medical professional (e.g., stage III/IV pressure ulcers, non-healing neuropathic, venous or arterial ulcers), and an individualized, multimodal program with regular (at least weekly) reassessment is in place; for home care, the member must also meet homebound criteria per CG-MED-23. It is not covered when skilled care is not required, when initial or continuing criteria are not met, or once the plan-of-care goals have been achieved.

"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."

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