Which wound care supplies can a SNF bill to Part B?
Surgical dressings are a statutory Part B benefit when they are medically necessary to treat a wound caused by, or treated by, a surgical procedure, or when debridement of the wound is medically necessary. Primary dressings that contact the wound and secondary dressings that hold them in place are both covered, within the LCD’s utilization limits.
What documentation does each dressing claim need?
- A qualifying wound diagnosis on the resident’s record
- An order that specifies the dressing type, size, and change frequency
- The wound location and a supporting wound assessment
- Usage within the LCD’s per-dressing change limits
- Administration records showing the dressing change actually happened
What CareComply monitors every day
Our Part B Supply Compliance Report runs against your eMAR daily and flags orders before month-end so your team can fix them while they are still billable.
- Missing qualifying diagnosis
- Missing dressing size or undefined frequency
- Missing wound location or supporting assessment
- Weekly utilization above LCD limits
- Debridement decisions that need clinical confirmation
Better products, better reimbursement
Because we read every wound order, we can point out where a different dressing would be clinically appropriate for the resident and reimburse more, for your clinical team to decide on.
Frequently asked questions
Can a nursing home bill Medicare Part B for wound dressings?
Yes. For residents not in a covered Part A stay who have active Part B, a SNF can bill medically necessary surgical dressings under its own NPI, following LCD L33831 and the standard documentation requirements.
Who bills for wound supplies today if we don’t?
Usually a Part B supply vendor that provides “free” supplies and bills Medicare under its own NPI. The reimbursement goes to the vendor instead of the facility that provides the care.
Do we have to change suppliers?
No. CareComply replaces the Part B supply vendor that bills Medicare under its own NPI today. Your facility keeps ordering from its regular supplier, now for all residents, and CareComply bills the Part B–eligible usage under your facility’s NPI.
Does this apply to residents in a Medicare Part A stay?
No. During a covered Part A stay, consolidated billing applies and supplies are part of the Part A payment. Part B supply billing applies to residents who are not in a covered Part A stay and have active Medicare Part B on the date of service.
Sources
- LCD L33831: Surgical Dressings
- Social Security Act §1861(s): medical and other health services
- CMS Medicare Claims Processing Manual, Pub. 100-04, Chapter 7 (SNF Part B billing)
- Article A55426: Standard Documentation Requirements for All Claims Submitted to DME MACs
Review status: Pending compliance review