Medicare is restricting access to advanced wound care. Starting January 1, 2026, the treatments that heal 95% of wounds may not be available.
"I can’t emphasize enough the most important factor in successful wound healing is early, appropriate assessment by wound care specialists. For Medicare beneficiaries, this covered service can prevent weeks or months of suffering and significantly reduce healthcare costs in the long run." Kenton Gray, Founder & CEO Kure Health
Many patients mistakenly believe that wound assessment is simply looking at the surface appearance, but modern wound care involves comprehensive evaluation of circulation, infection, nutrition status, and underlying conditions that may impair healing. For Medicare beneficiaries with diabetes, vascular disease, or mobility limitations, professional wound assessment isn't optional - it's essential for preserving health and independence.
Common conditions among Medicare beneficiaries, such as diabetes, peripheral artery disease, and immunosuppression, can greatly affect the body's ability to heal wounds. A proper assessment takes these factors into account and creates an effective treatment plan that is specific to your situation. Find out how non-healing wounds are treated.
What Wound Assessments Are Covered by Medicare?
Medicare Part B in 2025 usually covers wound assessments that are deemed necessary by your doctor and are performed by qualified healthcare providers. These assessments are deemed medically necessary when they evaluate non-healing wounds, pressure sores, diabetic ulcers, venous stasis ulcers, or post-surgical wounds with complications. Coverage usually includes the initial comprehensive assessment and subsequent re-assessments to monitor the progress of healing.
Medicare Coverage Component What's Included Requirements
Part B (Outpatient) Wound assessments in clinics, wound centers, and doctor's offices Physician order, documentation of medical necessity Part A (Hospital/SNF) Inpatient wound assessments and care Hospitalization or skilled nursing facility stay Home Health In-home wound assessments Homebound status, physician certification
For Medicare to cover your wound assessment, your doctor must document that it's medically necessary based on your specific condition. This documentation should detail why professional evaluation is required rather than self-care or basic nursing intervention. Factors that support medical necessity include wounds that haven't improved with standard care, signs of infection, wounds in patients with diabetes or vascular disease, and wounds with unusual characteristics.
Heightened Danger of Infection
If wounds are not evaluated by professionals, the danger of infection skyrockets. Even small wounds can house bacteria that grow quickly, particularly in elderly individuals with weakened immune systems or long-term conditions such as diabetes. These infections don't just stay local, they can rapidly get into the bloodstream, leading to systemic infection or sepsis, a deadly condition that necessitates immediate medical treatment. For more information, contact KureCare
Our skin is our body's first line of defense, acting as a protective barrier. When that barrier is broken, it's crucial to assess the wound properly and catch any early signs of infection before they worsen. Medicare will continue to cover necessary wound care assessments in 2026, provided they meet specific documentation and medical necessity requirements under Medicare Part B. For an immediate wound care assessment so that you can be potentially treated in 2025, contact KureCare today.
"As a wound care specialist for the past 45 years, I have seen a minor wound turn into a major infection that requires hospitalization too many times. Medicare beneficiaries should get their wounds assessed immediately, it's not just about financial concerns - it could save your life." - Dr. Krikor Tatoyan, First Choice Surgical, a KureCare facility
Did you know that seniors with untreated infected wounds are 5-6 times more likely to end up in the hospital than those who get their wounds assessed and treated in a timely manner? And the financial impact is no small matter—Medicare spends about $28 billion every year to treat wound infections that could have been prevented with early assessment and intervention.
Increased Risk of Hospital Stays
Wounds that worsen because they aren't professionally assessed can often lead to visits to the emergency room and long hospital stays. These hospital stays expose older people to more risks, including infections caught in the hospital, less mobility, and a decline in cognitive function. For those on Medicare already dealing with other health issues, hospital stays are detrimental to your health and can lead to a domino effect of complications that can affect the quality of life.
Statistics from Medicare show that hospital stays related to wounds typically last 8.2 days, which is longer than most other reasons for hospitalization, and often lead to patients being readmitted within a month. These avoidable hospital stays cost Medicare over $14,500 per patient on average, which is why the program emphasizes the importance of covering professional wound evaluations as a way to prevent these issues. You may be responsible for a portion of your hospital stay.
Amputation: A Severe Consequence
For Medicare beneficiaries with diabetes, amputation can be the most devastating result of inadequate wound assessment and care. Among seniors, lower extremity amputations due to non-healing wounds are among the most common yet preventable surgical procedures. Studies have shown that professional wound assessment and appropriate intervention can reduce the rate of amputation by up to 85% in high-risk groups.
Amputation doesn't just result in physical loss. It can also lead to mental health issues, decreased mobility, and increased reliance on others. This can greatly affect a autonomy and quality of life. Medicare provides coverage for comprehensive wound assessments to help prevent the need for amputations. This helps seniors maintain their physical abilities and dignity.
Why You Should Get a Professional Wound Assessment
When a trained wound care specialist assesses your wound, they can gather much more detailed information than you can by just looking at it. They'll examine the wound bed, the tissue around the wound, and the circulation in the area, among other things. This lets them come up with a treatment plan that's tailored to you, rather than a one-size-fits-all approach that might not work.
Medicare-covered assessments help to set a starting point for treatment protocol including measurement of the wound. This allows for a more objective way to monitor how well a wound is healing. This careful approach ensures that any necessary changes to treatment can be made quickly if a wound isn't healing as expected. This helps to prevent the "watch and wait" approach that often leads to a wound getting worse and causing complications.
Modern Diagnostic Equipment Used in Evaluations
Professional wound evaluations today use high-tech tools that do much more than just look at the wound. Digital wound measurement systems get the exact size and tissue makeup, vascular assessment tools check the blood flow to the wound area, and infrared thermography can find inflammation that can't be seen with the eye alone. Medicare usually covers these high-tech diagnostic parts when they are medically needed as part of a full wound evaluation plan.
Medicare-Covered Customized Treatment Plans
Once you've been professionally evaluated, if you're a Medicare beneficiary, you'll be able to take advantage of personalized treatment plans put together by wound care professionals. These plans could include advanced dressings, negative pressure therapy, cellular and tissue-based products, compression therapy, and other treatments that are specifically suited to the type of wound you have and your ability to heal.
The coverage that Medicare provides for these specialized treatments depends on the results of your first assessment and coverage varies greatly between 2025 and 2026. That's why it's so important to document everything during this process and have your doctor validate coverage. Your wound care specialist will determine the best treatments based on the findings of the assessment. They will also work to ensure that Medicare covers the cost by clearly documenting the medical necessity in your records.
Avoid Serious Problems
Maybe the biggest advantage of a professional wound assessment is stopping serious problems by spotting risk factors early. Experts can see small signs that show possible issues, like undermining (tunneling below wound edges), bad blood flow, or early biofilm formation, way before these problems are clear or have symptoms.
Wound care professionals can avoid complications by proactively addressing risk factors. This proactive approach is in line with KureCare's focus on preventing expensive hospital stays and complex procedures through proper early assessment and intervention.
Professional wound assessments provide a crucial foundation for effective wound management. By thoroughly evaluating your wound's characteristics and your overall health status, specialists can develop targeted interventions that address the specific factors impeding your healing. This personalized approach, that is covered by Medicare in 2025, significantly improves outcomes while reducing overall healthcare costs. Treatments for wound care based on Medicare 2026 will be limited and require extensive documentation and substantially reduced reimbursement.
Arrange Your Medicare-Covered Assessment in 4 Easy Steps
It's easy to arrange for your Medicare-covered wound assessment when you follow these four steps. Don't put off getting this important care. The sooner you get assessed, the better your chances of healing quickly and avoiding complications.
1. Get in Touch with Your Regular Doctor for a Referral
Begin by reaching out to your regular doctor to talk about your wound worries and then contact KURECare. Medicare may require a referral for coverage, and your regular doctor can supply crucial medical history details to the wound care team. Be detailed about your symptoms, how long you've had the wound, and any changes you've observed to help your doctor grasp the seriousness of your situation.
2. Collect Your Medicare Information and Medical History
Before your assessment appointment, make sure to have your Medicare card, supplemental insurance information, and a complete list of your current medications and allergies. Also collect records of any previous treatments you've received for the wound, including home care approaches, over-the-counter products used, and any instructions you've received from other healthcare providers. This comprehensive information helps ensure your assessment is thorough and Medicare processing goes smoothly.
3. Get in Touch with a Wound Care Center Approved by Medicare
Once you have your referral, reach out to a wound care center approved by Medicare to set up your assessment. Make sure they accept Medicare to avoid any surprise costs, and ask if there's any additional paperwork you need to bring to your appointment. KureCare has staff members who are dedicated to helping those on Medicare understand the coverage requirements for wound assessments and any treatments that follow.
4. Get Ready for Your Assessment
When the day of your appointment arrives, be sure to wear clothing that is not only comfortable but also loose enough to easily expose the wound area. Unless your referring physician has given you specific instructions to do so, do not apply any creams, ointments, or dressings. To give yourself enough time to fill out any necessary paperwork, be sure to arrive early. Also, don't forget to bring a list of any questions or concerns you'd like to go over with the wound care specialist during your assessment.
By taking these steps, you can guarantee a thorough wound assessment that is covered by Medicare and provides the specialized care you need. Keep in mind that this assessment is the crucial first step in healing and preventing any complications that could greatly affect your health and independence.
What Will Happen During Your Wound Assessment
KureCare designed the wound assessment experience to be comprehensive but also comfortable for those on Medicare. Knowing what will happen during the assessment can help you feel less anxious and more prepared to take an active role in your care. The whole assessment usually takes between 45 and 60 minutes and is the basis for all future treatment decisions.
At KureCare wound care centers, you'll find a welcoming, clinical setting equipped with the latest tools for a thorough examination. You'll have the chance to meet with a team of professionals, each with their own unique skills and knowledge to bring to your case. Typically, this includes a wound-certified nurse and a physician who specializes in wound care. Depending on your individual needs, other specialists may also be part of your team. This multidisciplinary approach guarantees that every facet of your wound and overall health is important when creating your treatment plan.
What to Expect at Your First Appointment
When you come in for your wound assessment, the first thing we'll do is go over your medical history in detail. We'll be looking for any conditions that could impact how your wound heals, such as diabetes, vascular disease, or immune disorders. The wound care specialist will ask you specific questions about your wound, like how and when it happened, what treatments you've tried, and how it's changed over time. This information about your past is critical for us to understand your wound's behavior.
The next step is a physical exam that involves not only the wound but also the skin around it, any nearby joints, and the blood flow to the area in question. The doctor will evaluate your overall mobility, nutritional status, and other factors that can affect your ability to heal. If you have a wound on your lower extremity, you can expect a detailed vascular assessment to determine if there is enough blood flow to the area for it to heal. To find out more about KureCare and our success rate contact us.
Our wound specialist will examine your wound carefully, using a gentle touch to measure its size, depth, and the type of tissue involved. They may need to probe the wound a little to check for any tunneling or undermining, which is where the wound extends under the skin. They will also look at the wound bed to identify different types of tissue, check for any drainage or odor, and look for signs of infection. While this examination may be a little uncomfortable, our team will do everything they can to keep any pain to a minimum.
When you come in for your Medicare-covered wound assessment, our wound care team will carry out a series of specialized tests and measurements. These are designed to help us understand your wound in detail and plan your treatment. We'll typically take digital photos of your wound, using measurement tools to record its exact size. We'll also measure its depth using sterile instruments and assess the tissue using specific classification systems. If we think your wound might be infected, we'll take cultures. If you have concerns about your circulation, we may carry out non-invasive vascular studies such as an ankle-brachial index (ABI) or a transcutaneous oxygen measurement (TCPO2). These will help us evaluate the blood flow and oxygen delivery to the wound.
How Your Assessment Results Influence Your Care
The results of your thorough wound assessment will directly affect the treatment plan your wound care specialist creates for you. They will take a careful look at all the information gathered during your assessment to identify the main issues preventing your wound from healing. They will then decide on the best methods to address these issues. Your specialist will consider the specifics of your wound, your overall health, your physical abilities, your support at home, and what Medicare will cover when creating a realistic and effective treatment plan.
Before you leave your appointment, you'll get a thorough rundown of the results of your assessment and any treatment recommendations. This usually includes the specific procedures for caring for your wound, the types of dressings you should use, how often to change your dressings, any guidelines for activity, nutrition advice, and when to schedule your next assessment. The plan will make it clear what parts are covered by Medicare and what paperwork you need to keep that coverage as your treatment continues.
Don't Delay: Schedule Your Medicare-Covered Wound Assessment Now
Don't wait until a minor wound turns into a serious health problem - schedule your Medicare-covered wound assessment now. Early intervention through professional assessment is the best way to prevent complications, reduce healing time, and maintain your independence and quality of life. At KureCare, our doctors have the experience to provide comprehensive wound assessments that meet all Medicare requirements and deliver the highest standard of care for our senior patients.
Common Questions
Many people on Medicare have unique questions about wound assessment coverage and procedures. These common questions address regular worries and give useful advice for using this crucial service.
Knowing the ins and outs of your coverage can help you stand up for yourself and get all the wound care benefits you're owed under your Medicare plan. If you have any questions that aren’t answered here, get in touch with your Medicare representative or contact KureCare.
How frequently does Medicare cover wound assessments?
Medicare generally covers an initial comprehensive wound assessment and follow-up assessments at medically appropriate intervals based on your condition. In 2025 most chronic wounds and reassessments are covered weekly or bi-weekly until significant improvement occurs, then at less frequent intervals as healing progresses. Your provider must document changes in wound status and medical necessity for each assessment to maintain Medicare coverage. If your wound significantly worsens or new wounds develop, additional assessments may be covered outside the regular schedule with proper physician documentation.
Changes to Medicare wound care coverage as of January 1, 2026 will change some of these rules. Check with the team at KURECare to give you the most recent updates on 2026 changes and how this will affect your benefits.
To try to take advantage of the 2025 Medicare wound care benefits, don't delay! Contact KureCare TODAY!!!
Is a referral necessary for a Medicare-covered wound assessment?
A referral from your primary care physician or specialist is usually required by Medicare for wound assessment services. This referral is used as proof of medical necessity, which is crucial for Medicare coverage. In certain emergency situations, an assessment may be done without a referral, but any subsequent care will still need the proper physician orders. If you are a beneficiary in a Medicare Advantage plan, your specific plan's network and authorization policies may have additional referral requirements.
What out-of-pocket costs could I still be responsible for?
Even though Medicare Part B covers 80% of the costs of approved wound assessments, you will typically be responsible for the remaining 20% coinsurance after you meet your annual deductible. If you have Medicare Supplement (Medigap) insurance, your plan may cover some or all of the coinsurance amount.
Other possible expenses might include travel to wound care appointments, specialized dressings or supplies for home use that go beyond what Medicare will cover, and services that Medicare does not deem medically necessary. To avoid surprise costs, always ask your wound care provider to confirm that Medicare will cover specific assessments and treatments before you go ahead with them.
Is it possible for me to have a wound assessment at home if I am homebound?
Absolutely, Medicare does cover wound assessments at home for beneficiaries who meet the criteria for being homebound and have a need for home health services that has been certified by a physician. These assessments are provided by home health agencies certified by Medicare with specialized wound care nurses. The coverage falls under the home health benefits of Medicare Part A, which typically does not require the 20% coinsurance of outpatient services. To qualify, you must be under the care of a doctor, require skilled nursing care on an intermittent basis, and meet the definition of "homebound" according to Medicare - meaning that leaving home requires a considerable amount of effort and assistance.
How can I tell if my wound care center takes Medicare?
All KureCare providers accept Medicare and the majority of other wound care centers do take Medicare, it's always a good idea to double-check before you schedule your assessment. You can do this by calling and asking the provider's office directly if they are a Medicare-participating provider.
If you're contacting a wound center, make sure to double-check that they accept your Medicare Advantage plan if you have one, as there could be network restrictions. To avoid any surprise bills, ask for written confirmation that they accept Medicare before you go to your appointment.
Being proactive about your wound care starts with knowing what your Medicare benefits cover. If you get the right documentation from your doctor and schedule your covered assessments on time, you can get the specialized care you need to help your wounds heal and avoid complications. It's important to remember that getting professional help early is the best way to make sure any wound heals, especially if you're a Medicare recipient with other health problems that could slow down healing.