Sending wound dressings home: how patient-direct ordering works

Who supplies the dressings

Check four situations before a patient-direct order goes out.

Home health. While a patient is under a Medicare home health plan of care, the law requires “consolidated billing of all home health services,” medical supplies such as dressings included (Claims Processing Manual, Ch. 10 §20). The agency that establishes the 30-day period “is the only entity that can bill and receive payment for medical supplies” during it (Benefit Policy Manual, Ch. 7), so the agency supplies the dressings.

Hospice. Hospice medical supplies “include those that are part of the written plan of care and that are for palliation and management of the terminal or related conditions” (42 CFR 418.202(f)), and Medicare contractors deny other suppliers' claims for supplies related to the terminal condition (Claims Processing Manual, Ch. 11 §40.2). Related dressings come from the hospice.

Inpatient stays. Billing the DME MAC for surgical dressings “provided during a stay in an inpatient facility that does not qualify as the beneficiary's home is not allowed” (Program Integrity Manual, Ch. 4 §4.7.3.1.2). In general, a patient in the hospital or in a Part A skilled nursing stay gets dressings from the facility.

Applied as part of a billed service. Dressings a treating practitioner applies as “part of a professional service that is billed to Medicare” are incident to that service and “are not separately payable”; “Claims for these dressings must not be submitted” (Policy Article A54563). Dressing changes sent home with the patient may be billed, with the patient's residence as the place of service, never the office (POS 11).

The standard written order

Dressings shipped to the patient need a standard written order (SWO). Under 42 CFR 410.38(d)(1), it has six elements:

1. Beneficiary Name or Medicare Beneficiary Identifier (MBI)
2. General Description of the item
3. Quantity to be dispensed, if applicable
4. Order Date
5. Treating Practitioner Name or National Provider Identifier (NPI)
6. Treating Practitioner Signature

The description can be a general description, a HCPCS code, a HCPCS code narrative or a brand name/model number. Separately billed supplies ordered at the same time can share one order; A55426 says to “List each separately.”

Surgical dressings aren't on CMS's Required Face-to-Face Encounter and Written Order Prior to Delivery List (the version effective October 28, 2026 lists 105 codes, none of them dressings). So the general rule applies: “the written order/prescription must be communicated to the supplier prior to claim submission” (42 CFR 410.38(d)(1)(ii)(B)). If the supplier bills “without first receiving a completed SWO, the claim shall be denied as not reasonable and necessary” (LCD L33831).

Signatures. Someone other than the treating practitioner may complete certain elements, “so long as the treating practitioner identified in the order” signs it (Program Integrity Manual, Ch. 5 §5.2.3). Signatures must be handwritten or electronic. A55426 says “Signature and date stamps are not allowed”; the Program Integrity Manual allows a rubber stamp only for an author with a physical disability who can provide proof.

Our standard written order builder lays out the six elements and prints the patient lines blank, so no patient information goes into this website.

What the chart needs to show

The order doesn't establish medical necessity on its own. The record “must contain sufficient documentation of the beneficiary's medical condition to substantiate the necessity for the type and quantity of items ordered,” and records from anyone with a financial interest in the claim “are not considered sufficient by themselves” (A55426).

For an initial evaluation, the Policy Article says the treating practitioner's record (or nursing home or home care nursing records) must specify:

• The type of qualifying wound: one caused by, or treated by, a surgical procedure, or a wound after debridement
• The location, number and size of the qualifying wounds treated with a dressing
• Whether the dressing is primary, secondary or for a noncovered use, such as wound cleansing
• The amount of drainage
• The type of dressing, the number or amount used at one time, and the frequency of dressing change
• Any other relevant clinical information

Revision R14 (December 5, 2024) removed “The size of the dressing (if applicable)” from this list.

This information “must be updated by the treating practitioner (or their designee) on a monthly basis.” For patients in a nursing facility, and for heavily draining or infected wounds, “wound evaluations are expected on a weekly basis.” Each evaluation records each wound's type, location, size (length × width) and depth, drainage, and other relevant status. If an evaluation can't be done in time, the record should say why and what other monitoring was used.

The evaluator can be a nurse, the treating practitioner or another health care professional involved in the patient's regular care, and “may have no financial relationship with the supplier,” a prohibition that doesn't extend to treating practitioners who are also the supplier. To test your templates, run the documentation self-check or see the documentation checklist.

When to write a new order

• Every 3 months, for each dressing. “A new order is required every 3 months for each dressing being used.”
• When a dressing is added or a quantity goes up. “A new order is needed if a new dressing is added or if the quantity of an existing dressing to be used is increased.”

Quantities: one month at a time

The LCD says “no more than a month's supply of dressings may be provided at one time,” unless the record documents why an individual patient needs more in the home setting. Quantities also “must take into account the status of the wound(s), the likelihood of change, and the recent use of dressings.”

Suppliers “must verify with the treating practitioner that any changed or atypical utilization is warranted.” The quantity on the order should match the documented change frequency; the quantity calculator turns that frequency into a monthly estimate, not an approved quantity.

Delivery and proof of delivery

The Program Integrity Manual recognizes three delivery methods: direct delivery, a delivery or shipping service, and delivery to a nursing facility for the patient. For direct delivery, proof of delivery is a signed and dated delivery document listing the patient, address, items, quantity and delivery date, with the patient's or designee's signature. With a carrier, it's a complete tracking record with evidence of delivery (A55426). No one with a financial interest in the delivery may sign for the patient.

“As a general Medicare rule, the date of service shall be the date of delivery”; a supplier using a shipping service may use the shipping date. The supplier keeps proof of delivery for seven years from the date of service, and under 42 CFR 424.516(f) the ordering practitioner keeps order documentation for 7 years too.

Refills

Refill rules changed on January 1, 2024. The supplier needs contact and an affirmative response “within 30 calendar days from the expected end of the current supply.” The date of service can be no earlier than 10 calendar days before that date, nothing ships automatically, and patients don't have to count what's left. Our refill guide has the details.

How patient-direct works with PCSS

Your office sends the order with the face sheet and plan of care; PCSS with its billing partners ships to the patient and bills the patient's coverage. Kits and collagen can go the same way; see our guides to wound care kits and collagen dressings.

Questions

Sources

Checked on October 6, 2026. Medicare policy changes; confirm current versions before relying on them. This page is general information, not billing, coding or legal advice.