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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101.The rules say that when dressing codes are billed for items covered under another benefit (e.g., gauze for a continent ostomy which is covered under the prosthetic device benefit) claims must be billed according to the documentation requirements specified in the applicable policy (see Ostomy Supplies policy for details.)QUALIFYING WOUNDSurgicaldressings are covered when a qualifying wound is present. A qualifying wound is defined as either of the following:A wound caused by, or treated by, a surgical procedure; or,After debridement of the wound, regardless of the debridement technique.The surgical procedure or debridement must be performed by a treating practitioner or other healthcare professional to the extent permissible under State law. Debridement of a wound may be any type of debridement (examples given are not all-inclusive):Surgical (e.g., sharp instrument or laser)Mechanical (e.g., irrigation or wet-to-dry dressings)Chemical (e.g., topical application of enzymes) orAutolytic (e.g., application of occlusive dressings to an open wound).Dressings used formechanical debridement, to cover chemical debriding agents, or to cover wounds to allow for autolytic debridement are covered although the debridement agents themselves are noncovered.Examples (not all-inclusive) of clinical situations in which dressings are noncovered under the Surgical Dressings benefit are:Drainage from a cutaneous fistula which has not been caused by or treated by a surgical procedure; or,A Stage I pressure ulcer; or,A first degree burn; or,Wounds caused by trauma which do not require surgical closure or debridement -e.g., skin tear or abrasion; or,A venipuncture or arterial puncture site (e.g., blood sample) other than the site of an indwelling catheter or needle.Claims for surgical dressings used for clinical conditions other than the qualifying wounds as described above will be denied as statutorily non-covered, no benefit. QUALIFYING DRESSING REQUIREMENTSProducts that are eligible to be classified as a surgical dressing are defined as:Primary dressings -Therapeutic or protective coverings applied directly to wounds or lesions either on the skin or caused by an opening to the skin.Secondary dressings -Materials that serve a therapeutic or protective function and that are needed to secure aprimary dressing. Items such as adhesive tape, roll gauze, bandages, and disposable compression material are examples of secondary dressings.Some items, such as transparent film, may be used as a primary or secondary dressing.The following are examples of wound care items which are non-covered under the surgical dressing benefit because they do not meet the statutory definition of a dressing (not all-inclusive):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;Gradient compression stockings (A6530, A6533, A6534, A6535, A6536, A6537, A6538, A6539, A6540, A6541, A6544, A6549);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.These dressings are noncovered under the surgical dressing benefit.Claims for products that are not able to be used as a primary or secondary dressing on a qualifying wound of the skin or that are composed of materials that do not serve a therapeutic or protective function will be denied as statutorily non-covered, no benefit.You can find this information in Medicare's Local Coverage Article: Surgical Dressings -Policy Article (A54563).If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.