Local Coverage Determination · DME MAC
L33831
Surgical Dressings
Version 48. CMS effective date 01/01/2024. CMS updated 02/08/2024. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
CMS coverage policy citation. CMS Manual System, Pub. 100-02, Benefit Policy Manual, Chapter 15, Section 100, 100-03, National Coverage Determinations Manual, Chapter 1, Sections 270.4 & 270.5
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. Medicare provides reimbursement for surgical dressing under the Surgical Dressings Benefit. This benefit only provides coverage for primary and secondary surgical dressing used on the skin on specified wound types. Refer to the related Policy Article NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES for information about these statutory requirements. In addition to the statutory requirements, for the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. The following are specific guidelines for individual product types. Alginate Or Other Fiber Gelling Dressing (A6196-A6199) Alginate or other fiber gelling dressing covers are covered for moderately to highly exudative full thickness wounds (e.g.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met to justify Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A54563 · Surgical Dressings - Policy Article
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
Related NCDs
- NCD 270.4 · Treatment of Decubitus Ulcers (version 1)
- NCD 270.5 · Porcine Skin and Gradient Pressure Dressings (version 1)
HCPCS codes on this LCD
118 other Level II codes are on the LCD and are not given a page in this set: A4461, A4463, A4465, A4490, A4495, A4500, A4510, A4649, A6010, A6011, A6021, A6022, A6023, A6024, A6025, A6154, A6196, A6197, A6198, A6199, A6203, A6204, A6205, A6206, A6207, A6208, A6209, A6210, A6211, A6212, A6213, A6214, A6215, A6216, A6217, A6218, A6219, A6220, A6221, A6222….
Questions
What does LCD L33831 cover?
L33831 is Surgical Dressings. It is a current final DME MAC local coverage determination, version 48.
Where is the CMS source for L33831?
The Medicare Coverage Database page for LCD L33831 version 48.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=A4450&as_of=2024-01-15&npi=1234567890&state=UT"