Wound and Burn Management and Specialized Treatment Centers

Policy Number: MA 4.028

Effective Date 9/1/2025

Policy

Specialized Wound or Burn Care may be considered medically necessary for the following types of wounds or burns:

• Requiring non-selective or selective debridement to facilitate healing or due to necrotic tissue, 97602 or;
• Requiring complex dressings, 16020, 16025, 16030, 29584 or;
• With documentation of signs of infection or risk factors for infection (e.g., diabetes mellitus, moderate dose of steroids, frail, elderly, poor nutrition, ischemia, venous insufficiency, etc.), or;
• 3rd degree or severe 2nd degree burns.

Documentation Requirements for Medical Necessity

The medical necessity for wound or burn care on a continuing basis for a given wound in a given individual is contingent upon evidence documented in the individual's record that the wound is improving in response to the wound care being provided. evidence of improvement includes measurable changes in at least two of the following:

• Drainage
• Inflammation
• Swelling
• Pain and/or Tenderness
• Wound dimensions (surface measurements, depth)
• Granulation tissue
• Necrotic tissue/slough
• Tunneling or undermining

Such evidence must be documented each time the individual is seen. a wound that shows no improvement after 30 days requires a new approach, which may include a physician reassessment of underlying infection, metabolic, nutritional, or vascular problems inhibiting wound healing, or a new treatment approach.

Specialized wound or burn care is considered investigational in the following circumstances:

• A superficial wound, less than 0.2mm in depth (i.e., abrasion, road rash, etc.), without documentation of signs of infection.
• A small-uncomplicated wound (< 0.5 cm. square) in an individual without documentation of risk factors for infection (e.g., diabetes mellitus, moderate dose of steroids, frail, elderly, poor nutrition, ischemia, venous insufficiency, etc.) or signs of infection.
• A mild burn (e.g., 1st degree or small area of 2nd degree)
• There is no documentation of the continued need for debridement, or current wound infection, or complex wounds or dressings.
• The management of acute wounds; the care of wounds that normally heal by primary intention, such as clean, incised traumatic wounds; surgical wounds, which are closed primarily; and other uncomplicated postoperative wound care.

Debridement of the wound(s) if there is no necrotic, devitalized, fibrotic, or other tissue or foreign matter present that would interfere with wound healing is investigational.

Procedures performed for cosmetic reasons or to prepare tissues for cosmetic procedures are considered investigational.

With appropriate management, it is expected that in most cases a wound will reach a state at which care can be performed primarily in a non-specialized office setting, and ultimately by the individual and/or the individual's caregiver with periodic physician assessment and supervision.

Wound care that can be performed in a non-specialized office setting or by the individual or the individual's caregiver is considered investigational.

Electrostimulation and Electromagnetic Therapy

Electrical stimulation and electromagnetic therapy for the treatment of wounds other than chronic stage iii or stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers are considered investigational. there is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

• E0761, E0769, G0282, G0295, 0906T, 0907T

Extracorporeal Shock Wave Therapy

The use of extracorporeal shock wave therapy is considered investigational as a treatment for wounds, as there is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

• 0512T, 0513T

Ablative Laser Treatment

The use of ablative laser treatment is considered investigational as a treatment for wounds, as there is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

• 17999

Near Infrared Spectroscopy

The use of near-infrared spectroscopy is considered investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

• 0640T, 0859T, 0860T

Transcutaneous Visible Light Hyperspectral Imaging

The use of transcutaneous visible light hyperspectral imaging is considered investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

• 0631T

Policy Guidelines

Conventional wound care includes optimization of nutritional status, debridement by any means to remove devitalized tissue, maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings, and necessary treatment to resolve any infection that may be present. Conventional wound care based on the specific type of wound includes frequent repositioning of a patient with pressure ulcers (usually every 2 hours), offloading of pressure and good glucose control for diabetic ulcers, establishment of adequate circulation for arterial ulcers, and the use of a compression system for patients with venous ulcers.

Measurable signs of improved healing include a decrease in wound size either in surface area or volume, decrease in amount of exudates, and decrease in amount of necrotic tissue.

Cross-References:

• MP 1.094 Skin Contact Monochromatic Infrared energy for the Treatment of Cutaneous Ulcers, Diabetic Neuropathy, and other Miscellaneous Musculoskeletal Conditions
• MP 2.033 Recombinant and Autologous Platelet-Derived Growth Factors as a Treatment of Wound Healing and Other Non-Orthopedic Conditions
• MP 2.070 Hyperbaric Oxygen Therapy (HBO)
• MP 4.004 Negative Pressure Wound Therapy in the Outpatient Setting
• MP 6.026 Durable Medical Equipment (DME) and Supplies
• MP 8.001 Physical Medicine and Specialized Physical Medicine Treatments (Outpatient)

Product variations

This policy is only applicable to certain programs and products administered by Capital Blue Cross and subject to benefit variations as discussed in Section VI. Please see additional information below

FEP PPO - Refer to FEP Medical Policy Manual. The FEP Medical Policy manual can be found at: https://www.fepblue.org/benefit-plans/medical-policies-and-utilization-management-guidelines/medical-policies

Description/Background

This policy discussion of wound care includes burns, which are considered a type of wound. Wound care involves evaluation and treatment of a wound including identifying potential causes of delayed wound healing and modifying treatment as directed by the certifying physician. Determining the agent of delayed wound healing such as vascular disease, infection, diabetes or other metabolic disorders, immunosuppression, unrelieved pressure, radiation injury and malnutrition will help determine the course of treatment. Evaluations could include comprehensive medical evaluation, vascular evaluation, orthopedic evaluation, and metabolic/nutritional evaluation leading to a plan of care. The plan may include metabolic corrections including dietary supplementation, specialized wound care, pressure relief, use of compression to manage edema, debridement and reconstruction, rehabilitation therapy, possible general, vascular and/or orthopedic surgery, and antimicrobial agents.

Referral to a wound care center would be most appropriate for those wounds that require advanced wound care techniques. Referral to a wound care center is not required for uncomplicated wounds, particularly traumatic wounds, in the absence of co-morbid conditions, which predictably impair wound healing (such as diabetes, ischemia, poor nutrition, venous insufficiency, among others). Referral is also impacted by the complexity of the wound (size, depth, infection, underlying exposed tissues) the chronic (or predictable chronic) duration of the wound, its progress toward healing in the primary caregiver’s hands, and even the location of the wound (wounds on weight bearing surfaces, those on the head and neck, those on the hands, and other locations, require special consideration).

Wound care centers are available to treat complicated wounds, but in many communities the experience, training, judgment, skill, and background to treat complex wounds also exists among vascular, general, plastic, orthopedic and other surgeons, dermatologists, podiatrists, or primary care physicians.

Wound care centers generally do not perform extensive surgical services, which may be required for optimal care. Such procedures may include debridement (minor debridement in the wound care center is appropriate), bypass or other vascular repair, plastic surgical reconstructions, flaps, amputations, and other procedures. Early surgical consultation for such procedures should be sought and the wound care center should not simply continue with more conservative measures when surgical treatment is necessary. There are some wounds which prove to be essentially chronic, and with which the patient will live indefinitely.

Active Wound Care Management Procedures

Active wound care procedures are performed to remove devitalized tissue and promote healing and involve selective and non-selective debridement techniques.

• Wound Care Selective Debridement
• Debridement is usually indicated whenever necrotic tissue is present on an open wound and may be indicated in cases of abnormal wound healing or repair. Debridement techniques usually progress from non-selective to selective but can be combined. Selective debridement should only be done under the specific order of a physician. Wound care selective treatments include:
• Conservative sharp debridement: Conservative sharp debridement is the classical method of selective wound debridement. Scalpel, curettes, scissors, and tweezers/forceps may be used and only clearly identified devitalized tissue is removed. Conservative sharp debridement is a minor procedure that typically requires no anesthesia and generally results in no bleeding.
• High Pressure Water Jet: Whirlpool provides a means where a wound can be submerged in water and, if appropriate, an additive agent is used for cleansing. Generally, whirlpool treatments do not require the skills of a physical therapist to perform, although a therapist may be required for an accurate assessment of the medical necessity of the whirlpool for the specific wound type. The skills, knowledge and judgment of a qualified physical therapist might be required when the patient's condition is complicated by circulatory deficiency, areas of desensitization, complex open wounds, and fractures. Immersion in the whirlpool to facilitate removal of a dressing would not be considered a skilled treatment modality.
• Lavage (non-immersion hydrotherapy) involves the use of an irrigation device, with or without pulsation, to provide a water jet to administer a shearing effect to loosen debris within a wound. Some electric pulsatile irrigation devices include suction to remove debris from the wound after it is irrigated. This does not include the Ultrasonic Wound Therapy System (MIST) system (see below).
• Wound Care Non-Selective Debridement
• These treatments include the following:
• Blunt Debridement: Blunt debridement is the removal of necrotic tissue by cleansing, scraping, chemical application or wet to dry dressing technique. It may also involve the cleaning and dressing of small or superficial lesions. Generally, this is not a skilled service and does not require the skills of a physician, podiatrist, therapist, or wound care nurse.
• 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; and it is the clinician’s 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; it is contraindicated for infected wounds.
• Mechanical Debridement: Wet-to-dry dressings may be used with wounds that have a high percentage of necrotic tissue. Wet-to-dry dressings should be used cautiously as maceration of surrounding tissue may hinder healing.
• Jet Hydrotherapy and Wound Irrigation: Mechanical debridement is used to remove necrotic tissue. They also should be used cautiously as maceration of surrounding tissue may hinder healing. Documentation must support the use of skilled personnel in order to be considered a skilled service.

Electrostimulation and Electromagnetic Therapy for the Treatment of Wounds

Standard Treatment

Conventional or standard therapy for chronic wounds involves local wound care, as well as systemic measures including debridement of necrotic tissues, wound cleansing, and dressing that promotes a moist wound environment, antibiotics to control infection, and optimizing nutritional supplementation. Avoidance of weight-bearing is another important component of wound management.

Electrostimulation

Since the 1950s, investigators have used electrostimulation to promote wound healing, based on the theory that electrostimulation may:

• Increase adenosine 5'-triphosphate concentration in the skin
• Increase DNA synthesis
• Attract epithelial cells and fibroblasts to wound sites
• Accelerate the recovery of damaged neural tissue
• Reduce edema
• Increase blood flow
• Inhibit pathogenesis

Electrostimulation refers to the application of electrical current through electrodes placed directly on the skin near the wound. The types of electrostimulation and devices can be categorized into groups based on the type of current. This includes low-intensity direct current, high-voltage pulsed current, and alternating current.

Electromagnetic Therapy

Electromagnetic therapy is a related but distinct form of treatment that involves the application of electromagnetic fields, rather than direct electrical current.

Regulatory Status

No electrostimulation or electromagnetic therapy devices have received approval from the U.S. Food and Drug Administration specifically for the treatment of wound healing. A number of devices have been cleared for marketing for other indications. Use of these devices for wound healing is off label.

Extracorporeal Shock Wave Therapy

Extracorporeal Shock Wave Therapy (ESWT) was originally used for stone management in urology and was subsequently introduced as treatment for various musculoskeletal disorders. Today, the application of ESWT have been expanded to new therapeutic fields including wound healing and has offered a potential solution for improving the wound-healing process.

Ablative Laser Treatment

Ablative fractional lasers has recently been employed for the treatment of hypertrophic and function-limiting scars. This therapy has been shown to induce healing of chronic wounds in patients with persistent ulcers and erosions within traumatic scars. Recent reports suggest it may be applicable to other types of chronic wounds as well. The mechanism of action for this modality has yet to be discovered but possible factors include laser-induced collagen remodeling, photomicrodebridement and disruption of biofilms, and induction of a proper wound healing cascade.

Near Infrared Spectroscopy

Near Infrared Spectroscopy (NIRS) is a noninvasive modality that measures maximum light absorption wavelengths of different components, including oxygen saturation, hemoglobin content, and water content, around wound sites. NIR imaging can also be used to estimate the depth of burn wounds. In addition, it has been utilized to monitor the wound healing process. However, due to the potential overlap/shifting of the absorption wavelengths of various components, NIRS can sometimes lack specificity.

Transcutaneous Visible Light Hyperspectral Imaging

HyperMed Imaging’s product, HyperView™, is a handheld, battery operated, portable diagnostic imaging device that is used to assess tissue oxygenation without contacting the patient. The product is intended for use by physicians and healthcare professionals as a noninvasive tissue oxygenation measurement system that reports an approximate value of oxygen saturation (O2Sat), oxyhemoglobin level (Oxy), and deoxyhemoglobin level (Deoxy) in superficial tissue. The HyperView system displays two-dimensional, color-coded images of tissue oxygenation of the scanned surface. Images and data provide hyperspectral tissue oxygenation measurements for selected tissue regions. The product is indicated for use to determine oxygenation levels in superficial tissues for patients with potential circulatory compromise, such as wound healing, diabetic foot ulcers, amputation, and critical limb ischemia.

Regulatory Status

The HyperView™ system was cleared via the FDA’s 501(k) process on December 16, 2016. Product Code: MUD

Rationale

Electrostimulation and Electromagnetic Therapy for Treating Wounds: Summary of Evidence

For individuals who have any wound type (acute or nonhealing) who receive electrostimulation, the evidence includes systematic reviews, a meta-analysis, and RCTs. Relevant outcomes are symptoms, change in health status, morbid events, quality of life, and treatment-related morbidity. Systematic reviews of RCTs on electrical stimulation have reported improvements in some outcomes, mainly intermediate outcomes such as a decrease in wound size and/or the velocity of wound healing. There are few analyses on the more important clinical outcomes of complete healing and the time to complete healing, and many of the trials are of relatively low quality. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have any wound type (acute or nonhealing) who receive electromagnetic therapy, the evidence includes two systematic reviews of RCTs (one on pressure ulcers and the other on leg ulcers) and an RCT of electromagnetic treatment following Cesarean section. Relevant outcomes are symptoms, change in health status, morbid events, quality of life, and treatment-related morbidity. The systematic reviews identified a few RCTs with small sample sizes that do not permit drawing definitive conclusions. The evidence is insufficient to determine the effects of the technology on health outcomes.

Extracorporeal Shock Wave Therapy: Summary of Evidence

For individuals who have any wound type who receive extracorporeal shock wave therapy plus standard wound care, the evidence includes RCTs and systematic reviews. ESWT showed therapeutic effects on acute and chronic soft tissue wound of different etiologies. However, the effectiveness of ESWT still requires further high quality, well-controlled RCTs with an adequate sample size because the existing clinical and experimental evidence has been limited. Furthermore, optimal ESWT regimens and dosages are required to provide evidence-based therapeutic guidance. The evidence is insufficient to determine the effects of the technology on health outcomes.

Ablative Laser Treatment

There are limited studies and overall effectiveness cannot be demonstrated. Larger, randomized, and controlled trials will need to be conducted to best determine appropriate treatment protocols. The evidence is insufficient to determine the effects of the technology on health outcomes.

Near Infrared Spectroscopy

There are limited studies and overall small sample sizes on this imaging and overall effectiveness cannot be demonstrated. The evidence is insufficient to determine the effects of the technology on health outcomes.

Transcutaneous Visible Light Hyperspectral Imaging

There are limited studies and proven efficacy on this imaging and overall effectiveness cannot be demonstrated. The evidence is insufficient to determine the effects of the technology on health outcomes.

Definitions

NA

Disclaimer

Capital Blue Cross’ medical policies are used to determine coverage for specific medical technologies, procedures, equipment, and services. These medical policies do not constitute medical advice and are subject to change as required by law or applicable clinical evidence from independent treatment guidelines. Treating providers are solely responsible for medical advice and treatment of members. These polices are not a guarantee of coverage or payment. Payment of claims is subject to a determination regarding the member’s benefit program and eligibility on the date of service, and a determination that the services are medically necessary and appropriate. Final processing of a claim is based upon the terms of contract that applies to the members’ benefit program, including benefit limitations and exclusions. If a provider or a member has a question concerning this medical policy, please contact Capital Blue Cross’ Provider Services or Member Services.

Coding Information

Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. The identification of a code in this section does not denote coverage as coverage is determined by the terms of member benefit information. In addition, not all covered services are eligible for separate reimbursement.

Extracorporeal Shock Wave Therapy is Investigational; therefore, not covered:

Electrostimulation and Electromagnetic Therapy for the treatment of wounds other than chronic Stage III or Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers are Investigational; therefore, not covered:

Ablative laser treatment is Investigational; therefore, not covered:

Near-infrared spectroscopy is Investigational; therefore, not covered:

Transcutaneous visible light hyperspectral imaging is Investigational; therefore, not covered:

Covered when medically necessary:

^*Appropriate ICD-10 codes for specialized wound or burn care could potentially involve any wound or burn diagnosis.

References

Electrostimulation and Electromagnetic Therapy for Treating Wounds

1. Barnes R, Shahin Y, Gohil R, et al. Electrical stimulation vs. standard care for chronic ulcer healing: a systematic review and meta-analysis of randomised controlled trials. Eur J Clin Invest. Apr 2014; 44(4): 429-40. PMID 24456185
2. Franek A, Kostur R, Polak A, et al. Using high-voltage electrical stimulation in the treatment of recalcitrant pressure ulcers: results of a randomized, controlled clinical study. Ostomy Wound Manage. Mar 2012; 58(3): 30-44. PMID 22391955
3. Houghton PE, Campbell KE, Fraser CH, et al. Electrical stimulation therapy increases rate of healing of pressure ulcers in community-dwelling people with spinal cord injury. Arch Phys Med Rehabil. May 2010; 91(5): 669-78. PMID 20434602
4. Kawasaki L, Mushahwar VK, Ho C, et al. The mechanisms and evidence of efficacy of electrical stimulation for healing of pressure ulcer: a systematic review. Wound Repair Regen. Mar-Apr 2014; 22(2): 161-73. PMID 24372691
5. Lala D, Spaulding SJ, Burke SM, et al. Electrical stimulation therapy for the treatment of pressure ulcers in individuals with spinal cord injury: a systematic review and meta-analysis. Int Wound J. Dec 2016; 13(6): 1214-1226. PMID 25869151
6. Liu LQ, Moody J, Traynor M, et al. A systematic review of electrical stimulation for pressure ulcer prevention and treatment in people with spinal cord injuries. J Spinal Cord Med. Nov 2014; 37(6): 703-18. PMID 24969965
7. Thakral G, La Fontaine J, Kim P, et al. Treatment options for venous leg ulcers: effectiveness of vascular surgery, bioengineered tissue, and electrical stimulation. Adv Skin Wound Care. Apr 2015; 28(4): 164-72. PMID 25775200
8. Arora M, Harvey LA, Glinsky JV, et al. Electrical stimulation for treating pressure ulcers. Cochrane Database Syst Rev. Jan 22, 2020; 1: CD012196. PMID 31962369
9. Girgis B, Duarte JA. High Voltage Monophasic Pulsed Current (HVMPC) for stage II-IV pressure ulcer healing. A systematic review and meta-analysis. J Tissue Viability. Nov 2018; 27(4): 274-284. PMID 30177421
10. Khouri C, Kotzki S, Roustit M, et al. Hierarchical evaluation of electrical stimulation protocols for chronic wound healing: An effect size meta-analysis. Wound Repair Regen. Sep 2017; 25(5): 883-891. PMID 29052946
11. Polak A, Kloth LC, Blaszczak E, et al. The Efficacy of Pressure Ulcer Treatment With Cathodal and Cathodal-Anodal High-Voltage Monophasic Pulsed Current: A Prospective, Randomized, Controlled Clinical Trial. Phys Ther. Aug 01, 2017; 97(8): 777-789. PMID 28789467
12. Aziz Z, Flemming K. Electromagnetic therapy for treating pressure ulcers. Cochrane Database Syst Rev. Dec 12, 2012; 12: CD002930. PMID 23235593
13. Aziz Z, Cullum N. Electromagnetic therapy for treating venous leg ulcers. Cochrane Database Syst Rev. Jul 02, 2015; (7): CD002933. PMID 26134172
14. Khooshideh M, Latifi Rostami SS, Sheikh M, et al. Pulsed Electromagnetic Fields for Postsurgical Pain Management in Women Undergoing Cesarean Section: A Randomized, Double-Blind, Placebo-controlled Trial. Clin J Pain. Feb 2017; 33(2): 142-147. PMID 28060214
15. Qaseem A, Humphrey LL, Forciea MA, et al. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. Mar 03, 2015; 162(5): 370-9. PMID 25732279
16. Bolton LL, Girolami S, Corbett L, et al. The Association for the Advancement of Wound Care (AAWC) venous and pressure ulcer guidelines. Ostomy Wound Manage. Nov 2014; 60(11): 24-66. PMID 25380098
17. Association for the Advancement of Wound Care (AAWC). Association for the Advancement of Wound Care guideline of pressure ulcer guidelines. Malvern, PA: AAWC; 2010.
18. Wound, Ostomy and Continence Nurses Society-Wound Guidelines Task Force. WOCN 2016 Guideline for Prevention and Management of Pressure Injuries (Ulcers): An Executive Summary. J Wound Ostomy Continence Nurs. May/Jun 2017; 44(3): 241-246. PMID 28472816
19. Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD) for Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds (270.1). 2004.
20. Zheng Y, Du X, Yin L, et al. Effect of electrical stimulation on patients with diabetes-related ulcers: a systematic review and meta-analysis. BMC Endocr Disord. Apr 27 2022; 22(1): 112. PMID 35477391
21. Blue Cross Blue Shield Association Medical Policy Reference Manual. 2.01.57, Electrostimulation and Electromagnetic Therapy for Treating Wounds. February 2024.

Other references

1. Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Electrical stimulation or electromagnetic therapy as adjunctive treatments for chronic skin wounds. TEC Assessments. 2005; Volume 20, Tab 2.
2. Chaby, Senet Vaneau et al. Dressings for acute and chronic wounds: A systematic review. Arch Dermatol 2007; 143: 1297-1304
3. Cherry GW, Wilson J. The treatment of ambulatory venous ulcer patients with warming therapy. Ostomy Wound Manage 1999; 45(9):65-70.
4. Franek A, Kostur R, Polak A, et al. Using high-voltage electrical stimulation in the treatment of recalcitrant pressure ulcers: results of a randomized, controlled clinical study. Ostomy Wound Manage. Mar 2012;58(3):30-44. PMID 22391955
5. Houghton PE, Campbell KE, Fraser CH, et al. Electrical stimulation therapy increases rate of healing of pressure ulcers in community-dwelling people with spinal cord injury. Arch Phys Med Rehabil. 2010;91(5):669-678.
6. Jones, Fennie, Lenihan. Chronic wounds: Factors influencing healing within 3 months and non-healing after 5-6 months of care. Wounds 2007; 19: 51-63.
7. Karr JC. External thermoregulation of wounds associated with lower-extremity osteomyelitis. A pilot study. J Am Podiatr Med Assoc 2003; 93(1):18-22.
8. Kawasaki L, Mushahwar VK, Ho C, et al. The mechanisms and evidence of efficacy of electrical stimulation for healing of pressure ulcer: a systematic review. Wound Repair Regen. Mar-Apr 2014;22(2):161-173. PMID 24372691
9. Armstrong D, de Asla RJ. Management of diabetic foot ulcers. In: UpToDate Online Journal [serial online]. Waltham, MA: UpToDate; updated October 30, 2024. Literature review current through December 2024.
10. Robinson C, Santilli SM. Warm-Up Active Wound Therapy: a novel approach to the management of chronic venous stasis ulcers. J Vasc Nurs 1998; 16(2):38-42.
11. Smith F, Dryburgh N, Donaldson J, Mitchell M. Debridement for surgical wounds. Cochrane Database Syst Rev. 2013;2013(9):CD006214. Published 2013 Sep 5. doi:10.1002/14651858.CD006214.pub4.
12. Vanceau, Chaby, Guillot et al. Consensus panel recommendations for chronic and acute wound dressings. Arch Dermatol 2007; 143: 1291-1294.
13. Department of Health & Human Services. Food and Drug Administration. Hyperview Hyperspectral Tissue Oxygenation Measurement System.
14. Nouvong A, Hoogwerf B, Mohler E, et al. Evaluation of Diabetic Foot Ulcer Healing with Hyperspectral Imaging of Oxyhemoglobin and Deoxyhemoglobin. Diabetes Care. 2009 Nov; 32(11):2056-2061. PMID 19641161
15. Chin JA, Wang EC, Kibbe MR. Evaluation of hyperspectral technology for assessing the presence and severity of peripheral artery disease. J Vasc Surg. 2011 Dec; 54(6):1679-88. PMID 21803525
16. Weingarten MS, Neidrauer M, Mateo A, et al. Prediction of wound healing in human diabetic foot ulcers by diffuse near-infrared spectroscopy: A pilot study. Wound Repair Regen. 2010;18(2):180-185 PMID: 23110417
17. Li S, Mohamedi AH, Senkowsky J, Nair A, Tang L. Imaging in Chronic Wound Diagnostics. Adv Wound Care (New Rochelle). 2020;9(5):245-263. doi:10.1089/wound.2019.0967.
18. Gould L, Stuntz M, Giovannelli M, et al. Wound Healing Society 2015 update on guidelines for pressure ulcers. Wound Repair Regen. 2016;24(1):145-162. doi:10.1111/wrr.12396.
19. Morton LM, Dover JS, Phillips TJ, Krakowski AC, Uebelhoer NS. Treatment of ulcers with ablative fractional lasers. Semin Cutan Med Surg. 2015;34(1):37-41. doi:10.12788/j.sder.2015.0128.
20. Zhang L, Fu XB, Chen S, Zhao ZB, Schmitz C, Weng CS. Efficacy and safety of extracorporeal shock wave therapy for acute and chronic soft tissue wounds: A systematic review and meta-analysis. Int Wound J. 2018;15(4):590-599. doi:10.1111/iwj.12902
21. Lu Q, Yin Z, Shen X, Li J, Su P, Feng M, Xu X, Li W, He C, Shen Y. Clinical effects of high-intensity laser therapy on patients with chronic refractory wounds: a randomised controlled trial. BMJ Open. 2021 Jul 12;11(7):e045866. doi: 10.1136/bmjopen-2020-045866. PMID: 34253665; PMCID: PMC8276284
22. Blue Cross Blue Shield Association Medical Policy Reference Manual. 2.01.41, Noncontact Radiant Heat Bandage for the Treatment of Wounds. July 2009. (Archived)

Policy History

• MA 4.028 - 03/03/2025 Policy Creation; Partial Adoption. Removed statements for noncontact ultrasound and noncontact radiant heat bandage. Modified electrical stimulation and electromagnetic statement to read that wounds other than chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers are INV. Removed codes 11000, 11001, 11042-11047, 29581, 97597, 92598, 97610, G0281, G0329, A6000, E0231, and E0232

Health care benefit programs issued or administered by Capital Blue Cross and/or its subsidiaries, Capital Advantage Insurance Company^®, Capital Advantage Assurance Company^® and Keystone Health Plan^® Central. Independent licensees of the Blue Cross BlueShield Association. Communications issued by Capital Blue Cross in its capacity as administrator of programs and provider relations for all companies.