Wound and Ulcer Care

This LCD covers evaluation and active wound care, including selective and non-selective debridement and certain adjunctive modalities (e.g., low-frequency non-contact ultrasound) for wounds that are refractory to healing or complicated by infection, necrosis, biofilm, vascular, metabolic, or pressure-related factors. Coverage requires a documented individualized Plan of Care with vascular and metabolic/nutritional assessment, wound measurements, justification for debridement, and adherence to adjunctive measures; several services (routine dressing changes, cleansing-only removal of debris, and investigational methods) are excluded or considered bundled/not separately payable. Specific modality and timing rules apply (e.g., LF ultrasound 2–3x/week with improvements expected after six treatments; Plan of Care and vascular assessment expected within 30 days).

"Wound care is covered for wounds and ulcers refractory to healing or with complicated healing cycles due to the wound's nature or complicating metabolic/physiologic factors."