Wound Care Billing Services Visit After Visit.
Wound care is billed by depth, by area and by progress. Payers review the whole course of treatment, not one visit, so every note needs measurements, tissue and a plan. We bill from that record and flag gaps before they become denials.
- Debridement by depth and area
- Skin substitute rules for 2026
- Office, home and facility settings
First 20 sq cm or less, then add-on codes for each additional 20 sq cm at the same depth. No real patient data.
Your Wound ClinicianMeasures every visit
Depth Picks The Code. Area Picks The Units.
Two wounds debrided to the same depth are added together. Wounds debrided to different depths are reported separately.
| Deepest tissue removed | First 20 sq cm or less | Each additional 20 sq cm | Type |
|---|---|---|---|
| Epidermis, dermis, wound surface | 97597 | 97598 | Selective |
| Subcutaneous tissue | 11042 | 11045 | Surgical |
| Muscle or fascia | 11043 | 11046 | Surgical |
| Bone | 11044 | 11047 | Surgical |
Payers Read The Whole Course.
Ongoing wound care is reviewed against progress over time. A note without measurements, or a wound that is not improving without a documented change in plan, is where reviews start.
| Visit | Length × width × depth | Area | Tissue | Drainage | Interventions |
|---|---|---|---|---|---|
| Week 1 | 4.2 × 3.0 × 0.4 cm | 12.6 sq cm | Slough 40% | Moderate | Debridement, compression |
| Week 2 | 3.9 × 2.8 × 0.3 cm | 10.9 sq cm | Slough 25% | Moderate | Debridement, compression |
| Week 3 | 3.5 × 2.5 × 0.3 cm | 8.8 sq cm | Granulation 80% | Light | Compression, offloading |
| Week 4 | 3.1 × 2.2 × 0.2 cm | 6.8 sq cm | Granulation 90% | Light | Plan reviewed |
A Big Payment Change For Skin Substitutes.
Under the 2026 Medicare Physician Fee Schedule, most skin substitutes used in the office are paid as incident-to supplies rather than as biologicals. Coverage expectations still come from your Medicare contractor and each commercial plan.
Trunk, arms and legs use one code family; face, scalp, hands, feet and genitalia use another. Each family splits by total wound size: up to 100 sq cm is reported per 25 sq cm (first 25, then each additional 25); 100 sq cm or more is reported per 100 sq cm.
Wound type and duration, standard care already tried and its result, and measurements. Many payer policies expect a period of failed standard care first.
The product, size used, wound area and lot. We check each claim against the current contractor and plan policy before it goes out.
Where The Patient Is Changes Who Bills What.
Your Office
You bill the visit, procedures and, where allowed, supplies used in the office.
The Patient's Home
You bill your service. Dressings the patient uses at home are usually billed by a DME supplier.
Nursing Facility
During a covered Part A skilled stay, consolidated billing means the facility bills most supplies. Your professional service is still yours.
Hospital Outpatient
The hospital bills its facility portion and you bill the professional portion.
Medical Billing Or Full RCM?
Medical Billing
Your team keeps registration, eligibility and authorizations. We bill debridement, skin substitute applications and visits from your notes and follow every response. Coding can be added.
About Medical Billing Services →Full RCM
We also check eligibility, handle authorizations for products that need them and code every visit, with credentialing included.
About Full RCM →Supplies billed by a separate DME supplier, and facility claims for hospital wound centers, are outside this service unless we confirm them in writing.
Questions Wound Care Practices Ask.
Please do not send patient records or wound photos through the website.
How Do You Decide Between Selective And Surgical Debridement?
From the deepest tissue your clinician documents removing. If the note does not support the deeper level, we bill what it supports or ask first.
Do You Add Up Wound Areas?
Yes, for wounds debrided to the same depth. Wounds at different depths are reported separately.
How Has Skin Substitute Billing Changed In 2026?
Medicare now pays most office-applied skin substitutes as incident-to supplies under the Physician Fee Schedule. We check each claim against your contractor's and each plan's current policy.
Can You Bill For Patients In Nursing Facilities?
Yes, your professional services. During a covered skilled nursing stay the facility bills most supplies, so we confirm the patient's status first.
Talk Through Your Wound Care Billing.
Tell us where you see patients, the procedures and products you use, and your payer mix. Please do not send patient records or wound photos through the website.
- Debridement by depth and area
- BAA signed before any patient-data access
- Medical Billing or Full RCM