Article Detail - JD DME

Here are some examples of wound care items that are non-covered under the surgical dressing benefit because they do not meet the statutory definition of a dressing:

• Skin sealants or barriers (A6250)
• Wound cleansers (A6260) or irrigating solutions
• Solutions used to moisten gauze (e.g., saline)
• Silicone gel sheets (A6025)
• Topical antiseptics
• Topical antibiotics
• Enzymatic debriding agents
• Gauze or other dressings used to cleanse or debride a wound but not left on the wound
• First-aid type adhesive bandage (A6413)
• Any item listed in the latest edition of the Orange Book (e.g., an antibiotic-impregnated dressing which requires a prescription)
• Surgical stockings (A4490, A4495, A4500, A4510)
• Non-elastic binder for an extremity (A4465)
• Small adhesive bandages (e.g., Band-Aid or similar product) are not primarily used for the treatment of wounds addressed in the Surgical Dressings policy.

Products that can't be used as primary or secondary dressings on qualifying skin wounds, or those made of materials without therapeutic or protective benefits, will be denied as statutorily non-covered, with no benefit provided. This ensures that only items meeting the specific criteria for surgical dressings are covered under the benefit.