Medicare Payment System for Surgical Dressings Containing Silver

    Manufacturers considering the addition of silver to their wound care dressing lines are usually surprised to learn that Medicare’s Durable Medical Equipment Regional Carrier (DMERC) Fee Schedules do not allow higher payments for surgical dressings that contain silver.

Medicare explained its position by stating, “If surgical dressings are impregnated with or otherwise incorporate drugs, coding of the dressing is based on the other materials and features of the product without regard to the drug. This principle is applied to the coding of dressings containing silver. If the other material meets the definition of a dressing (eg, gauze, foam), the product must be billed using one of those HCPCS codes. If the other material serves only to deliver silver to the wound and does not meet the definition of a dressing, the product must be billed with HCPCS code A9270, non-covered item or service. HCPCS code A4649 must not be used for silver-containing dressings.” To correct this situation, professional societies, manufacturers, scientists, and the Centers for Medicare and Medicaid Services (CMS) should work together to develop unique HCPCS codes and categories for silver-containing surgical dressings. [Ed. Note: See this month’s editorial on page 10 for more thoughts on this subject.]

    This situation creates a dilemma for Medicare Part B beneficiaries who change their dressings at home in-between wound assessment visits either to their physician’s office or to the hospital-owned outpatient wound care department. Some silver-containing dressings:
  • are covered by Medicare Part B and the patient is required to pay the 20% copayment
   • are not covered by Medicare Part B and the patient must pay the entire cost of these dressings
  • are cost-effective for DME supplier to stock
  • cost the DME suppliers more than the DME supplier is reimbursed by Medicare. Therefore, they will not supply these dressings.

    When physicians order silver containing surgical dressings, they should consider:
  • The patient’s wound condition
  • The DMERC’s surgical dressing local coverage determination (LCD) guidelines regarding the HCPCS code/category verified for the various dressings
   • Whether the dressing has a HCPCS code that has been verified by the Statistical Analysis DMERC
  • The DME supplier’s affordability of the silver-containing dressings that are appropriate for the patient’s condition
  • The patient’s copayment for the silver-containing dressings.

    Table 1 reviews the HCPCS codes, surgical dressing LCD guidelines, 2006 DMERC fee schedule rate, and 2006 beneficiary copayment rate for silver-containing dressings with verified HCPCS codes valid at the time this column was written (December 2005). This information, along with the DME supplier’s acquisition cost for the various dressings, should help the physician and beneficiary select a silver-containing dressing appropriate to the patient’s medical condition. Although additional silver-containing surgical dressings are available, they do not yet have verified HCPCS codes. Clinicians should check with the respective manufacturers to determine if/when those dressings are expected to have verified HCPCS codes.