MP-19 Surgical Dressings Form

Medical Policy Surgical Dressings Page 1

Policy Number: MP-19 Current Effective Date: Original Effective Date: 6/15/2018 Next Review/Revision Date: Plans: QUEST Integration (Medicaid) & AlohaCare Advantage Plus Special Needs Plan (SNP Medicare)

1. Purpose 1.1 The purpose of this policy is to define medically necessary indications for surgical dressings to treat a qualifying wound.

2. Policy 2.1 This policy covers medically necessary surgical dressings limited to primary and secondary dressings used for treatment of a qualifying wound in outpatient wound care setting only. The qualifying wound must have been caused by, or treated by, a surgical procedure that has been performed by a physician or other health care professional. 2.2 The quantity and type of dressings dispensed at any one time must take into account the current status of the wound(s), the likelihood of change, and the recent use of dressings. Dressing needs may change frequently (e.g. weekly) in the early phases of wound treatment and/or with heavy draining wounds and must be tailored to the specific needs of an individual. Suppliers are expected to have a mechanism for determining the quantity of dressings that the person is actually using and to adjust their provision of dressings accordingly.

   2.3 Dressings over a percutaneous catheter or tube (e.g. intravascular, epidural, nephrostomy, etc.) are covered as long as the catheter or tube remains in place and after removal until the wound heals.
   Surgical dressings required after debridement of a wound are also covered, irrespective of the type of debridement, as long as the debridement was reasonable and necessary.

   2.4 The frequency of recommended dressing changes depends on the type and use of the surgical dressing. When combinations of primary dressings, secondary dressings, and wound filler are used, the change frequencies of the individual products should be similar.

3. Definitions 3.1 Non-healing wounds – wounds such as, but not limited to pressure ulcers, diabetic ulcers, ischemic ulcers, or venous ulcers. 3.2 Qualifying wound – a wound caused by, or treated by, a surgical procedure; or, after debridement of the wound, regardless of the debridement technique. Note: wounds caused by trauma which do not require surgical closure or debridement – e.g., skin tear or abrasion are not covered under the Surgical Dressings benefit. 3.3 Primary dressing – therapeutic or protective coverings applied directly to wounds or lesions either on the skin or caused by an opening to the skin. 3.4 Secondary dressing – materials that serve a therapeutic or protective function that are needed to secure a primary dressing (e.g. adhesive tape, roll gauze, bandages, and disposable compression material).

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3.5 Staging of Pressure Ulcers – for the purpose of this policy, staging definition is as follows (National Pressure Ulcer Advisory Panel, 2016): a. Stage 1 Pressure Injury: Non-blanchable erythema of intact skin b. Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis c. Stage 3 Pressure Injury: Full-thickness skin loss d. Stage 4 Pressure Injury: Full-thickness skin and tissue loss e. Unstageable Pressure Injury: Obscured full-thickness skin and tissue loss f. Deep Tissue Pressure Injury: Persistent non-blanchable deep red, maroon or purple discoloration intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. 3.6 Surgical dressing – Include both primary dressings and secondary dressings. 3.7 Surgical wounds – include open abdominal wounds, open amputation, and wound dehiscence. 3.8 Wound Debridement – removal of necrotic (devitalized) wound tissue and is indicated for both acute and chronic wounds when necrotic tissue or foreign matter are present. Types of debridement include: a. Surgical (e.g. sharp instrument or laser); b. Mechanical (e.g. irrigation or wet-to-dry dressings); c. Chemical (e.g. topical application of enzyames); or d. Autolytic (e.g. application of occlusive dressings to an open wound

4. Procedure
   4.1 Surgical Dressings are covered when all of the medical necessity criteria of each dressing have been met. a. Alginate or Other Fiber Gelling Dressing (A6196-A6199) is covered under conditions listed below unless otherwise stated.
5. Moderately to highly exudative full thickness wounds and/or wound cavities such as stage III or IV ulcers.
6. Dressing change is once per day. One wound sheet of the approximate wound size or up to two units of wound filler (one unit = six inches of alginate or other fiber dressing rope) is usually used at each dressing change.
7. Not medically necessary for dry wounds or wounds covered with eschar or if used concurrently with hydrogels. b. Collagen Dressing or Wound Filler (A6010, A6011, A6021-A6024) is covered under conditions listed below unless otherwise stated.
8. Wounds that are full thickness or subcutaneous in depth and with mild to moderate drainage, or have stalled or have not progressed toward a healing goal.
9. Dressing or wound filler can stay in place up to seven days, depending on the specific product.
10. Up to 12‐week supply for collagen products.
11. Not medically necessary for wounds with heavy exudate, third-degree burns, or when an active vasculitis is present. c. Composite Dressing (A6203-A6205) is covered under conditions listed below unless otherwise stated.

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1. Moderately to highly exudative wounds.
2. Change up to three times per week is considered medically necessary, one wound cover per dressing change. d. Contact Layer (A6206-A6208) is covered under conditions listed below unless otherwise stated.
3. Used to line the entire wound to prevent adhesion of the overlying dressing to the wound.
4. Dressing change up to once per week is considered medically necessary.
5. They are not medically reasonable and necessary when used with any dressing that has a non-adherent or semi-adherent layer as part of the dressing. They are not intended to be changed with each dressing change. e. Foam Dressing or Wound Filler (A6209-A6215) is covered under conditions listed below unless otherwise stated.
6. Used on full thickness wounds (e.g. stage III or IV ulcers) with moderate to heavy exudate;
7. Dressing change for a foam wound cover used as a primary dressing is up to three times per week;
8. Dressing change for a foam wound cover used as a secondary dressing up to three times per week for wounds with very heavy exudate;
9. Dressing change frequency for foam wound fillers is up to once per day. f. Gauze, Non-impregnated (A6216-A6221, A6402-A6404, A6407) is covered under conditions listed below unless otherwise stated.
10. Dressing change up to three times per day for a dressing without a border and once per day for a dressing with a border.
11. Stacking more than two gauze pads on top of each other in any one area is not considered medically necessary. g. Gauze, Impregnated, With Other Than Water, Normal Saline, Hydrogel, or Zinc Paste (A6222- A6224, A6266) is covered under conditions listed below unless otherwise stated.
12. Coverage is based upon the characteristics of the underlying material(s).
13. Dressing change for gauze dressings impregnated with other than water, normal saline, hydrogel or zinc past is up to once per day. h. Hydrocolloid Dressing (A6234-A6241) is covered under conditions listed below unless otherwise stated.
14. Hydrocolloid dressings are covered for use on wounds with light to moderate exudate.
15. Dressing change for hydrocolloid wound covers or fillers up to three times per week. i. Hydrogel Dressing (A6231-A6233, A6242-A6248) is covered under conditions listed below unless otherwise stated.
16. Used on full thickness wounds with minimal or no exudate (e.g. stage III or IV ulcers).
17. Dressing change once per day is considered medical adequate for hydrogel wound covers without an adhesive border or hydrogel wound fillers. Dressing change for hydrogel wound covers with adhesive border is up to three times per week.
18. Quantity of hydrogel filler used for each wound must not exceed the amount needed to line the surface of the wound. Additional amounts used to fill a cavity are not reasonable and necessary. Maximum utilization of code A6248 is three units (fluid ounces) per wound in 30 days.

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4. Use of more than one type of hydrogel dressing (filler, cover, or impregnated gauze) on the same wound at the same time is not reasonable and necessary.
5. Not medically necessary for stage II ulcers. j. Specialty Absorptive Dressing (A6251-A6256) is covered under conditions listed below unless otherwise stated.
6. Used for moderately or highly exudative wounds (e.g. stage III or IV ulcers).
7. Dressing change once per day for a dressing without an adhesive border and up to every other day for a dressing with a border. k. Transparent film (A6257-A6259) is covered under conditions listed below unless otherwise stated.
8. Used on open partial thickness wounds with minimal exudate or closed wounds.
9. Dressing change up to three times per week. l. Wound filler, Not Elsewhere Classified (A6261-A6262) is covered under conditions listed below unless otherwise stated.
10. Based upon the characteristics of the underlying material(s). Dressing change is up to once per day. m. Wound pouch (A6154) is covered under conditions listed below unless otherwise stated.
11. Dressing change up to three times per week. n. Zinc Paste Impregnated Bandage (A6456) is covered under conditions listed below unless otherwise stated.
12. Treatment of venous leg ulcers that meet the statutory requirements for a qualifying wound (surgically created or modified, or debrided).
13. Dressing change frequency is weekly.
14. Claims for A6456 used for treatment of venous insufficiency without a qualifying wound or when used for other non-qualifying conditions will be denied as statutorily non- covered, no benefit. o. Tape (A4450, A4452) is covered under conditions listed below unless otherwise stated.
15. Used to hold on a wound cover, elastic roll gauze or non-elastic roll gauze.
16. Additional tape is not required when a wound cover with an adhesive border is used.
    Reasons for use of additional tape must be well documented.
17. Tape change is determined by the frequency of change of the wound cover. Quantities of tape submitted must reasonably reflect the size of the wound cover being secured.
18. Utilization per dressing change for wound covers measuring: o 16 square inches or less is up to two units o 16 to 48 square inches is up to three units o 48 square inches is up to four units p. Light Compression Bandage (A6448-A6450), Moderate/High Compression Bandage (A6451, A6452), Self-Adherent Bandage (A6453-A6455), Conforming Bandage (A6442-A6447), Padding Bandage (A6441) are covered under conditions listed below unless otherwise stated.
19. Most compression bandages are reusable. Frequency of replacement would be no more than one per week unless they are part of a multi-layer compression bandage system.
20. Conforming bandage dressing change is determined by the frequency of change of the selected underlying dressing.
21. Claims for compression bandages and multi-layer systems used without a qualifying

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wound or when used for other non-qualifying conditions will be denied as statutorily non- covered, no benefit. q. Gradient Compression Stockings/Wrap (A6531, A6532, A6545) is covered under conditions listed below unless otherwise stated. Also see AlohaCare’s Compression Garments (Gradient) for the Extremities Medical Policy.

1. Gradient compression stocking described by codes A6531 or A6532 or a non-elastic gradient compression wrap described by code A6545 is only covered when used in the treatment of an open venous stasis ulcer that meets the qualifying wound requirements.
2. Limited to one per six months per leg. Quantities exceeding this amount are not medically reasonable and necessary.
3. Codes A6531, A6532, and A6545 are not covered for the following conditions: o Venous insufficiency without stasis ulcer; o Prevention of stasis ulcers; o Prevention of the reoccurrence of stasis ulcers that have healed; o Treatment of lymphedema in the absence of ulcers. r. Compression Burn Garments (A6501-A6513) is covered under conditions listed below unless otherwise stated.

4. Used to reduce hypertrophic scarring and joint contractures following a burn injury.

   4.2 Prior Authorization (PA) Clinical Documentation Required: a. Clinical information that is up to date and supports the necessity of the type and amount of surgical dressings. Assessments to include:

5. Type and number of wounds;
6. Location;
7. Size (Length x Width cm.);
8. Depth;
9. Drainage amount b. Documentation of monthly or more frequent wound evaluations (more frequent for those in nursing facilities or with heavily draining/infected wounds), to include:
10. Treatment plan;
11. Type of dressing, reason for, and whether the dressing is being used as a primary or secondary dressing (must be obtained from the physician, nursing home, or home care nurse) or for some non-covered use even if the quantity used has remained the same or decreased;
12. Wound healing log to include wound history, recurrence and characteristics (location, staging, size, base, exudates, infection condition of surrounding skin and pain, as well as status of the periwound tissues such as pigmented, scarred, atrophic, cellulitic);

13. Duration and description of the standard wound treatments that have been tried and/or failed. c. Medical necessity for excessive wound care visits and/or dressing.

    4.3 A separate PA is required for a new order at least every three months for each dressing being used and when a new dressing is added or the quantity of an existing dressing is increased.

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4.4 PA is not required for a. Gauze, Non-impregnated (A6216-A6221, A6402-A6404, A6407); b. Transparent film (A6257-A6259); c. Wound filler (A6261-A6262); d. Wound pouch (A6154); e. Tape (A4450, A4452); f. Light compression bandage (A6448-A6450), moderate/high compression bandage (A6451, A6452), self-adherent bandage (A6453-A6455), conforming bandage (A6442-A6447), padding bandage (A6441); g. MEDI honey dressing (A4649).

4.5 Code Specific Requirements a. When codes A4649, A6261 OR A6262 are used, there must be a narrative description of the product, manufacturer, brand name/number, and information justifying medical necessity. b. The appropriate modifier (A1-A9, AW, EY, or GY) must be added when applicable.

4.6 Dressings Covered Under Other Medicare Benefits a. When dressings are covered under other Medicare benefits, there is no separate payment using surgical dressing codes. Examples, not all-inclusive, are:

1. Dressings used with infusion pumps (covered under the DME benefit) are included in the allowance for code A4221.
2. Dressings used with parenteral nutrition (covered under the prosthetic device benefit) are included in the allowance for code B4224.
3. Dressings used with gastrostomy tubes for enteral nutrition (covered under the prosthetic device benefit) are included in the allowance for codes B4034-B4036.
4. Dressings used with tracheostomies (covered under the prosthetic device benefit) are included in the allowance for code A4625 and A4629.

5. Dressings used with dialysis access catheters (covered under the end stage renal disease benefit) are included in the composite rate (outpatient facility dialysis) or payment cap (method one home dialysis) paid to the dialysis provider. b. Allowance for items referred to using the term “kit” (e.g. in HCPCS codes A4625, A4629, B4224, B4034, B4035, B4036) includes not only the individual major supply items, but also any gauze, tape, other dressing supplies, etc. necessary for their use.

6. Limitations 5.1 Claims for products that are not able to be used as a primary or secondary dressing on a qualifying wound of the skin or that are composed of materials that do not serve a therapeutic or protective function will be denied as statutorily non-covered, no benefit. Dressing supplies without a prescription; or purchased by the patient over-the-counter; or given to the patient as take home supplies is not covered.

   5.2 The following wound care items are considered not medically necessary and not covered under the surgical dressings benefit (not all-inclusive): a. Gauze, Impregnated, Water or Normal Saline (A6228-A6230);

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b. Skin sealants or barriers (A6250); c. Wound cleansers (A6260) or irrigating solutions; d. Solutions used to moisten gauze (e.g. saline); e. Silicone gel sheets (A6025); f. Topical antiseptics; g. Topical antibiotics; h. Enzymatic debriding agents; i. Gauze or other dressings used to cleanse or debride a wound but not left on the wound; j. First-aid type adhesive bandages (e.g. Band-Aid or similar product) are not primarily used for the treatment of wounds and does not meet the definition of a surgical dressing (A6413); k. Any item listed in the latest edition of the Food and Drug Administration (FDA) Orange Book (e.g. an antibiotic-impregnated dressing which requires a prescription); l. Gradient compression stockings (A6530, A6533-A6544, A6549). Compression dressings are covered for use on qualified wounds. A venous ulcer that meets the statutory benefit requirements to be classified as a qualifying wound would be eligible for dressing coverage.
Compression items used for the treatment of conditions such as edema often associated with venous ulcers are outside of the scope of the Surgical Dressings benefit. m. Surgical stockings (A4490-A4510); n. Small adhesive bandages (e.g. Band-Aid or similar product) are not primarily used for the treatment of wounds addressed in the Surgical Dressings benefit.

5.3 Examples (not all-inclusive) of clinical situations in which dressings are not covered under the surgical dressings benefit are: a. Drainage from a cutaneous fistula which has not been caused by or treated by a surgical procedure; or b. A Stage I pressure ulcer; or c. First degree burn; or d. Wounds caused by trauma which do not require surgical closure or debridement – e.g., skin tear or abrasion; or, e. Venipuncture or arterial puncture site (e.g. blood sample) other than the site of an indwelling catheter or needle.

5.4 Other Considerations a. It is not reasonable and necessary to use a secondary dressing with primary dressings that contain an impervious backing layer with or without an adhesive border. b. It is not appropriate to use combinations of a hydrating dressing on the same wound at the same time as an absorptive dressing (e.g. hydrogel and alginate). c. Use of more than one type of wound filler or more than on type of wound cover in a single wound is not reasonable and necessary. The exception is a primary dressing composed of:

1. An alginate or other fiber gelling dressing; or,
2. A saline, water, or hydrogel impregnated gauze dressing. Either of these might need an
   additional wound cover.

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6. Coding Information The following medical codes are relevant codes for diagnosis and procedures for surgical dressing and for informational purposes only. All the medical codes listed in this policy do not constitute or imply benefit coverage or provider reimbursement.

   CPT Description PA Policy 11042 Debridement, SubQ, First 20 sq cm or less No PA 11043 Debridement, Muscle/Fascia, first 20 sq cm or less No PA 11044 Debridement, Bond, first 20 sq cm or less No PA 11045 Debridement SubQ, each addl 20 sq cm or part thereof No PA 11046 Debridement, Muscle/Fascia, each addl 20 sq cm or part thereof No PA 11047 Debridement, Bone, each addl 20 sq cm or part thereof No PA 11100 Biopsy Skin ‐ one lesion No PA 11055 Pairing/Cutting benign hyperkeratotic lesion (eg: corn/callus): single PA 29445 Apply Total Contact leg Case No PA 29580 Apply Unna Boot No PA 29581 Application of multi‐layer compression system; leg including ankle and foot No PA 93922 Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries No PA 93923 Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels No PA 97597 Debridement, Open wound, first 20 cm2 or less No PA 97598 Debridement, Open wound, each addl 20 sq cm No PA 97602 Removal of Devitalized Tissue from wound PA

   HCPCS Modifiers – The appropriate modifier must be added when applicable. A1 – Dressing for one wound A2 – Dressing for two wounds A3 – Dressing for three wounds A4 – Dressing for four wounds A5 – Dressing for five wounds A6 – Dressing for six wounds A7 – Dressing for seven wounds A8 – Dressing for eight wounds A9 – Dressing for nine wounds AW – Item furnished in conjunction with a surgical dressing EY – No physician or other licensed health care provider order for this item or service GY – Item or service statutorily noncovered or does not meet the definition of any Medicare benefit LT – Left side

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RT – Right side HCPCS Description PA Policy A4450 Tape, non‐waterproof, per 18 square inches No PA A4452 Tape, waterproof, per 18 square inches No PA A4461 Surgical dressing holder, non‐reusable, each No PA A4463 Surgical dressing holder, reusable, each No PA A4649 Surgical supply; miscellaneous. There must be a narrative description of the product, manufacturer, brand name/number, and information justifying medical necessity. No PA A6010 Collagen based wound filler, dry form, sterile, per gram of collagen No PA A6011 Collagen based wound filler, gel/paste, per gram of collagen No PA A6021-A6023 Collagen dressing, sterile No PA A6024 Collagen dressing wound filler, sterile, per 6 inches No PA A6025 Gel sheet for dermal or epidermal application, (e.g. silicone, hydrogel, other), each. Note: Not covered under SNP Medicare. Covered only under QI. No PA A6154 Wound pouch, each No PA A6196-A6198 Alginate or other fiber gelling dressing, wound cover, sterile No PA A6199 Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches No PA A6203-A6205 Composite dressing, sterile No PA A6206-A6208 Contact layer, sterile No PA A6209-A6214 Foam dressing, wound cover, sterile No PA A6215 Foam dressing, wound filler, sterile, per gram No PA A6216-A6218 Gauze, non‐impregnated, non‐sterile No PA A6219-A6221 Gauze, non‐impregnated, sterile No PA A6222-A6224 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile No PA A6228-A6230 Gauze, impregnated, water or normal saline, sterile. Note: Not covered under SNP Medicare. Covered only under QI. No PA A6231-A6233 Gauze, impregnated, hydrogel, for direct wound contact, sterile No PA A6234-A6239 Hydrocolloid dressing, wound cover, sterile No PA A6240 Hydrocolloid dressing, wound filler, paste, sterile, per ounce No PA A6241 Hydrocolloid dressing, wound filler, dry form, sterile, per gram No PA A6242-A6247 Hydrogel dressing, wound cover, sterile No PA A6248 Hydrogel dressing, wound filler, gel, per fluid ounce No PA A6250 Skin sealants, protectants, moisturizers, ointments, any type, any size. Note: Not covered under SNP Medicare. Covered only under QI. No PA A6251-A6256 Specialty absorptive dressing, wound cover, sterile No PA A6257-A6259 Transparent film, sterile No PA A6260 Wound cleansers, any type, any size. Note: Not covered under SNP Medicare. Covered only under QI. No PA A6261 Wound filler, gel/paste, per fluid ounce, not otherwise specified. There must be a narrative description of the product, manufacturer, brand name/number, and information justifying medical necessity. No PA

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A6262 Wound filler, dry form, per gram, not otherwise specified. There must be a narrative description of the product, manufacturer, brand name/number, and information justifying medical necessity. No PA A6266 Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard No PA A6402-A6404 Gauze, non‐impregnated, sterile No PA A6407 Packing strips, non‐impregnated, sterile, up to 2 inches in width, per linear yard No PA A6410-A6412 Eye pad No PA A6441 Padding bandage, non‐elastic, non‐woven/non‐knitted, width greater than or equal to three inches and less than five inches, per yard No PA A6442-A6444 Conforming bandage, non‐elastic, knitted/woven, non‐sterile No PA A6445-A6447 Conforming bandage, non‐elastic, knitted/woven, sterile No PA A6448-A6450 Light compression bandage, elastic, knitted/woven No PA A6451 Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard No PA A6452 High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard No PA A6453-A6455 Self‐adherent bandage, elastic, non‐knitted/non‐woven No PA A6456 Zinc paste impregnated bandage, non‐elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard No PA A6457 Tubular dressing with or without elastic, any width, per linear yard No PA A6501-A6511 Compression burn garment No PA A6512 Compression burn garment, not otherwise classified No PA A6513 Compression burn mask, face and/or neck, plastic or equal, custom fabricated No PA A6530 Gradient Compression Stocking, below knee, 18-30 mmHg, each. Note: Not covered under SNP Medicare. Covered only under QI. PA A6531 Gradient Compression Stocking, below knee 30-40 mmHg, each PA A6532 Gradient Compression Stocking, below knee 40-50 mmHg, each PA A6533-A6535 Gradient Compression Stocking, thigh length. Note: Not covered under SNP Medicare. Covered only under QI. PA A6536-A6538 Gradient Compression Stocking, full length/chap style. Note: Not covered under SNP Medicare. Covered only under QI. PA A6539-A6541 Gradient Compression Stocking, waist length. Note: Not covered under SNP Medicare. Covered only under QI. PA A6544 Gradient Compression Stocking, garter belt. Note: Not covered under SNP Medicare. Covered only under QI. PA A6545 Gradient Compression Stocking, non-elastic, below knee 30-50 mmHg, each PA A6549 Gradient Compression Stocking, stocking/sleeve, not otherwise specified.
Note: Not covered under SNP Medicare. Covered only under QI. PA

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7. Reference/Resource 7.1 Cartwright DJ. A Closer Look at the New ICD-10-CM Codes for Wound Management in 2020. Today’s Wound Clinic. 2019 October:13(10). 7.2 Centers for Medicare and Medicaid Services (CMS). National Coverage Policy. Local Coverage Determination (LCD): Surgical Dressings (L33831). (Contractor: Noridian Healthcare Solutions, LLC) Revision effective date: 01/01/2019. 7.3 Centers for Medicare and Medicaid Services (CMS). Local Coverage Article: Surgical Dressings – Policy Article (A54563). (Contractor: Noridian Healthcare Solutions, LLC) Revision effective date: 01/01/2019. 7.4 CGS Administrators, Surgical Dressings Comments and Response Summary – 2015 Draft LCD Released for Comment August 2015. Posted June 8, 2017. Accessed on 8/29/2019. 7.5 Centers for Medicare and Medicaid Services (CMS). Local Coverage Article: Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426). (Contractor: Nordiian Healthcare Solutions, LLC). Revision effective date: 01/01/2019. 7.6 Centers for Medicare and Medicaid Services (CMS). Medicare Benefit Policy Manual; Chapter 15-Covered Medical and Other health Services. Rev-259, date: 07-12-2019. 7.7 Centers for Medicare and Medicaid Services (CMS). Medicare Learning Network (MLN). MLN Fact Sheet: Provider Compliance Tips for Surgical Dressings. February 2018. Accessed on 8/29/2019. 7.8 Cullum, Nicky, Buckley, et al. Wounds Research for Patient benefit: a 5 year programme of research. Health technology assessment (2016). Pp. 1-334. https://doi.org/10.3310/pgfar04130. 7.9 Dabiri G, Damstetter E, Phillips T. Choosing a Wound Dressing Based on Common Wound Characteristics. Adv Wound Care (New Rochelle). 2016 Jan 1;5(1):32-41. 7.10 Dumville JC; Deshpande S; O’Meara S; et al. Hydrocolloid dressings for healing diabetic foot
   ulcers. Cochrane Database of Systematic Review-Intervention. 06 August 2013. 7.11 Gonzalez AC, Costa TF, Andrade ZA, et al. Wound healing – A literature review. An Bras Dermatol. 2016 Sep-Oct;91(5):614-620. Doi: 10.1590/abd1806-4841.20164741. 7.12 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan
   Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Wound Care and
   Pain Management – an extract from the Clinical Practice Guideline. 2014. Accessed on
   8/29/2019. 7.13 Shi C, Dumville JC, Cullum N. Compression bandages or stockings versus no compression for
   treating venous leg ulcers (Protocol). Cochrane Database of Systematic Reviews 2019, Issue 8.
   Art. No.: CD013397. 7.14 Smith F; Dryburgh N; Donaldson J; et al. Debridement for surgical wounds. Cochrane Database
   of Systematic Review-Intervention. 05 September 2013. 7.15 Vermeulen H; van Hattem JM; Storm-Versloot MN; et al. Topical silver for treating infected
   wounds. Cochrane Database of Systematic Review-Intervention. 24 January 2007. 7.16 Walker RM; Gillespie BM; Thalib L; et al. Foam dressings for treating pressure ulcers. Cochrane
   Systematic Review-Intervention. 12 October 2017. 7.17 Weir D. The Surgical Dressing Policy: Still Alive and Well. Today’s Wound Clinic. 2011
   May;5(4).

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8. Review/Revision History 6/15/2020 - Retired