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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 state that Covered Indications for wound care include: 
 
    Medicare would expect that wound care may be necessary for the following types of wounds: 
        Surgical wounds that must be left open to heal by secondary intention. 
        Infected open wounds induced by trauma or surgery. 
        Wounds with biofilm. 
        Wounds associated with complicating autoimmune, metabolic, and vascular or pressure factors. 
        Wounds complicated by necrotic tissue and/or eschar. 
    Active Wound Care Management 
    Debridement may be indicated whenever necrotic tissue as well as cellular or proteinaceous debris is present 
on an open wound in order to keep the wound in an active state of healing. Debridement may also be indicated 
in cases of abnormal wound healing or repair. The routine application of a topical or local anesthetic does not 
elevate active wound care management to surgical debridement. Debridement may be categorized as selective 
or non-selective. 
        Wound Care Selective Debridement includes: 
            Removal of specific, targeted areas of devitalized or necrotic tissue from a wound along the margin of 
viable tissue by sharp dissection utilizing scissors, scalpel, curette, and/or tweezers/forceps. This procedure 
typically requires no anesthesia and generally has no or minimal associated bleeding. 
        Wound Care Non-Selective Debridement may include: 
            Mechanical Debridement: This type of debridement is the removal of necrotic tissue by cleansing, or 
appropriate use of dressings. Removal of debris and dressing changes are not considered a skilled or separate 
service. 
            Enzymatic Debridement: Debridement with topical enzymes is used when the necrotic substances to be 
removed from a wound are protein, fiber, and collagen. The manufacturers product insert contains indications, 
contraindications, precautions, dosage, and administration guidelines; it is the clinicians responsibility to 
comply with those guidelines. 
            Autolytic Debridement: This type of debridement is indicated where manageable amounts of necrotic 
tissue are present, and there is no infection. Autolytic debridement occurs when the enzymes that are naturally 
found in wound fluids are sequestered under synthetic dressings. 
            Maggot / larvae therapy: Debridement with medical-grade maggots in wounds. 
    Wound Care Surgical Debridements 
        Conditions that may require surgical debridement of large amounts of skin may include but are not limited to: 
            rapidly spreading necrotizing process (sometimes seen with aggressive streptococcal infections), 
            severe eczema, 
            extensive skin trauma (including large, abraded areas with ground-in dirt), or 
            autoimmune skin diseases. 
        Surgical debridement occurs only if material has been excised and is typically reported for the treatment 
of a wound to clear and maintain the site free of devitalized tissue including but not limited to necrosis, eschar, 
slough, infected tissue, biofilm, abnormal granulation tissue, etc., and should be accomplished to the margins of 
viable tissue. 
        These procedures can be very effective but represent extensive debridement. They may be complex in 
nature and may require the use of anesthesia. 
    Use of Evaluation and Management (E/M) Codes in Conjunction with Surgical Debridements 
        Patients who have chronic wounds may frequently have underlying medical problems that require 
concomitant management in order to bring about wound closure. In addition, patients may require education, 
other services, and coordination of care both in the preoperative and postoperative phases of the debridement 
procedure. An E/M service provided and documented on the same day as a debridement service may be 
covered by Medicare only when the documentation clearly establishes the service as a "separately identifiable 
service" that was reasonable and necessary, as well as distinct, from the debridement service(s) provided. 
    Negative Pressure Wound Therapy (NPWT) 
        See coverage provisions of the Noridian Durable Medical Equipment (DME) LCD L33821 
    Low-Frequency, Non-Contact, Non-Thermal Ultrasound 
        Low frequency, non-contact, non-thermal ultrasound describes a system that uses continuous low-
frequency ultrasonic energy to produce and propel a mist of liquid and deliver continuous low-frequency 
ultrasound to the wound bed. 
        Low-Frequency, Non-Contact, Non-Thermal Ultrasound is considered reasonable and necessary wound 
therapy and therefore eligible for coverage by Medicare when provided for any of the following clinical 
conditions: 
            Wounds and ulcers which are too painful for sharp or excisional debridement and have failed 
conventional debridement with documentation supporting the same. 
            Wounds and ulcers meeting Medicare coverage for debridement but with documented contraindications 
to sharp or excisional debridement. 
            Wounds and ulcers meeting Medicare coverage for debridement where the normal process of healing 
has not progressed as expected at 30 days. 
        Low-frequency, non-contact, non-thermal ultrasound is considered reasonable and necessary when 
provided two to three times per week. The length of individual treatments will vary per wound size. 
        Observable, documented improvements in the wound(s) should be evident after six treatments. 
Improvements include documented reduction in pain, necrotic tissue, or wound size, or improved granulation 
tissue. 
    Application of Paste Boot (Unna Boot) may be of value, as is the use of Total Contact Casting. Application 
of a Multi-Layer Compression System may be a useful component of wound care management, particularly 
with venous ulcerations of the lower extremity. 
 
You can find this information in the Local Coverage Determination (LCD) Wound and Ulcer Care L38904. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.