wound care billing for PTs

How should PTs bill for "non-skilled" wound care treatments, for treatments that don't require sharp debridement, compression, or wound vac? I'm thinking specifically a pt visit where a simple dressing change is indicated (pt can't complete on their own because of a host of reasons), or a visit where significant patient education is provided to increase pt independence with self mgmt, i.e., transitioning pt to increased self mgmt for decreased frequency of skilled care, or similarly transitioning pt to self mgmt for discharge, or also training in use of compression garments and such. Non-selective debridement (97602) seems appropriate for dressing changes, but therapeutic activity (97530) or self care/ adl training (97535) seems more appropriate for the education-heavy treatments. Thanks in advance.

Jun 5, 2023 by Adam Copp,

1 replies

Tiffany Hamm
BSN, RN, CWS, ACHRN, UHMSADS

Hi Adam,

Thank you for the question. I will point you to some specific Local Coverage Determinations (LCD's) for your region and Medicare Administrative Contractor (MAC) which is Novitas.
All of these resources can be found in Wound Reference at this link: https://woundreference.com/app/topic?id=medicare-coverage-determinations-for-wound-care

Scroll to the bottom to find a list of LCD's for Novitas. You will see a helpful link included below:

L35036 Therapy and Rehabilitation Services (PT, OT) [65] https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=35036&ver=118&keyword=wound+care&keywordType=all&areaId=all&docType=NCA%2cCAL%2cNCD%2cMEDCAC%2cTA%2cMCD%2c6%2c3%2c5%2c1%2cF%2cP&contractOption=name&contractorName=6&sortBy=relevance&bc=AAAAAAQAAAAA&KeyWordLookUp=Doc&KeyWordSearchType=And

Additionally, there are other resources on the Novitas site that may assist you:
https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00086531

Even though an LCD may be retired or superseded, it can still provide valuable information regarding billing and medical necessity.

I hope this was helpful,

Tiffany

Jun 6, 2023

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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