Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures

Incision and drainage is covered for true abscesses and for non-abscess fluid collections when medically necessary for pain, inflammation, or infection, with coverage extending to complicated abscesses requiring more extensive debridement. Coverage requires documentation of abscess/pus and clinical signs, a full procedure description, and adherence to provider scope (especially for podiatrists); routine foot care maneuvers (e.g., simple nail trimming, nail fragment removal) and procedures for blisters without superinfection are not payable as I&D. Repeated I&Ds are generally not expected but may be allowed for hidradenitis suppurativa if the provider documents why definitive therapy is not appropriate.

"Incision and drainage (I&D) is covered for treatment of abscesses, defined as a circumscribed collection of pus in any location causing infection."

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