Can we dispense surgical dressings to patients who have medical insurance that is not Medicare Part B? Yes! Many non-Medicare third-party payers provide coverage for surgical dressings.
The Rules
Some non-Medicare third-party payers that provide coverage for surgical dressings for their beneficiaries have their own surgical dressing policy. Similar to the Durable Medical Equipment Medicare Administrative Contractor (DMEMAC) policies that many providers are familiar with that apply to Part B Medicare Patients, these non-Medicare policies normally have detail coverage requirements, compliance considerations, and documentation guidelines. These may be identical to, very similar, or significantly different than the DMEMAC guidelines that apply to Medicare beneficiaries. Providers cannot make the mistake of assuming that the DMEMAC surgical dressing policy apply to non-Medicare third-party payers.
One Example
The largest non-Medicare medical insurance company in the United States is United Healthcare. United Healthcare has its own Durable Medical Equipment (DME) policy which can be found here:
When viewing this, it is clear that United Healthcare has different policies and requirements for different types of DME. In the above listed United Healthcare DME policy items are listed in alphabetical order in the left-hand column of the document. Scrolling down in alphabetical order, providers will see the option of “Dressing/Bandages” options listed in “Surgical Dressings.”
In this United Healthcare surgical dressings policy, United Healthcare refers to the Medicare Benefit Policy Manual and the DMEMAC coverage policies for specific guidelines. United Healthcare often follows the same guidelines as Medicare for coverage of services and they do the same here for surgical dressings. for those already familiar with the DMEMAC coverage guidelines, this makes dispensing surgical dressings for United Healthcare patients seamless.
Conclusion
Do not limit your provision of surgical dressings to only Medicare patients. There are many non-Medicare third-party payers that also provide coverage for surgical dressings and this allows us the ability to provide this valuable service to even more patients!
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
Dr. Lehrman is a podiatrist practicing in Fort Collins, CO and operates Lehrman Consulting, LLC which provides consultation services regarding coding, compliance and documentation. Dr. Lehrman is a Certified Professional Coder and Certified Professional Medical Auditor. He serves as a staff liaison at the AMA CPT® Editorial Panel meetings where CPT codes are created, edited, and deleted. He is a Diplomate of the American Board of Foot and Ankle Surgery, Fellow of the American Society of Podiatric Surgeons, and is recognized as a “Master” by the American Professional Wound Care Association. Dr Lehrman is a Fellow of the American Academy of Podiatric Practice Management, Past Director of the American Professional Wound Care Association Board of Directors, and is a Past Chairman of the Board of the American Society of Podiatric Surgeons. Dr. Lehrman is also on the editorial advisory board of the journal WOUNDS.
