Before The First Application
The record has to show that the wound did not respond to appropriate standard care for the period the MAC requires before advanced therapy was started.
- Wound type, location, duration and the diagnosis codes that match the LCD
- Standard care provided and its dates: offloading for diabetic foot ulcers, compression for venous leg ulcers, moisture management, infection control and debridement as needed
- Measured response to standard care over the required period
- Vascular assessment and, for diabetic patients, glycemic control
- Smoking status and other factors that affect healing
At Every Application
- Length, width and depth, and the total surface area treated
- Product name and manufacturer, size, lot or serial number, and the area applied
- Wound bed condition and any debridement performed
- Application method and securing dressing
- Response since the last application and the reason to continue
When The Wound Stalls
If a wound is not getting smaller, the note should say so and explain the plan. Continuing applications without documented progress, or without a documented reason to continue, is a common audit finding. Most policies cap the number of applications per episode, so the plan should be addressed well before the limit.
What Changed In 2026
With skin substitutes paid as incident-to supplies under the 2026 rules, payment is tied to the documented wound size in square centimeters. Discarded product does not increase payment, and the JW and JZ modifiers are no longer used for these products. Clear wound measurements at each visit carry even more weight than before.
Frequently Asked Questions
- Is a photograph enough to document wound size?
- Photographs help, but reviewers expect measured length, width and depth recorded in the note. Use photos as support, not a substitute.
- Does the referring physician's note count toward standard of care?
- It can, if it is in the record and documents the dates, treatment and measured response. Obtain and file those records before the first application.
Billing Support For This Specialty
Physicians Professional Billing Services, Inc. has billed wound care, surgical and procedural specialties since 1998, across every Medicare Part B MAC jurisdiction.
Primary Sources
This page is general information about billing and coverage rules and is not legal, coding or reimbursement advice for a specific claim. Coverage policies change; confirm current requirements with CMS and the applicable Medicare Administrative Contractor.