CMS NCD 47 Decubitus Ulcer Treatment Coverage: What Changes in 2026

CMS has modified National Coverage Determination (NCD) 47, which governs Medicare coverage for the treatment of decubitus ulcers. This update, effective March 12, 2026, reaffirms hydrotherapy (whirlpool) as a covered service while drawing a clear line around non-covered treatments whose safety and effectiveness have not been established. If your facility bills for wound care services under Medicare, this policy deserves a close read.

What NCD 47 Covers: CMS Medicare Policy on Decubitus Ulcer Treatment

The Centers for Medicare & Medicaid Services (CMS) classifies decubitus ulcer treatment under the Physicians' Services benefit category. Under NCD 47, the foundational covered approach involves removing dead tissue from ulcer lesions and keeping them clean to promote new tissue growth — a process that can be accomplished through hydrotherapy, commonly known as whirlpool treatment.

CMS covers hydrotherapy (whirlpool) for decubitus ulcers when the treatment is deemed reasonable and necessary for the individual patient. That "reasonable and necessary" standard is the critical threshold your documentation must meet. Medical records need to support that hydrotherapy is clinically appropriate given the patient's wound status, overall condition, and care setting.

This policy falls under Physicians' Services, meaning it applies broadly across care settings where physicians or qualified non-physician practitioners are directing wound care — including outpatient wound centers, skilled nursing facilities (SNFs), and home health contexts where applicable.

What CMS Does NOT Cover Under NCD 47: Non-Covered Decubitus Ulcer Treatments

This is where billing teams need to pay close attention. NCD 47 explicitly identifies a category of decubitus ulcer treatments that are not covered under Medicare because their safety and effectiveness have not been established. CMS provides the following examples of non-covered treatment modalities:

• Ultraviolet light
• Low intensity direct current
• Topical application of oxygen
• Topical dressings with Balsam of Peru in castor oil

These are cited as examples, not an exhaustive list — meaning CMS's intent is to exclude any treatment modality that lacks established safety and effectiveness, even if it doesn't appear word-for-word in this list. If a provider is using a novel or emerging wound care approach for decubitus ulcers and billing Medicare, you need documentation that the specific modality is covered, not just that decubitus ulcer treatment broadly is covered.

Billing non-covered services to Medicare — even inadvertently — creates denial exposure and potential overpayment liability. The distinction CMS draws here is meaningful and enforceable.

Medical Necessity Documentation Requirements for Medicare Wound Care Billing

Because hydrotherapy coverage hinges on "reasonable and necessary," your documentation needs to do real work. At minimum, clinical notes supporting a covered hydrotherapy claim should address:

CMS does not specify a prior authorization requirement within NCD 47 itself. However, that does not eliminate the possibility that your Medicare Administrative Contractor (MAC) has local coverage determination (LCD) policies that layer additional requirements on top of the NCD. Always check with your MAC for any applicable LCDs related to wound care in your jurisdiction.

Affected Codes

This policy does not list specific CPT or HCPCS codes. NCD 47 defines coverage at the service and clinical criteria level without enumerating procedure codes directly. Billing teams should reference their MAC's LCD guidance and the CMS Claims Processing Instructions cross-referenced in the policy to identify the appropriate codes for hydrotherapy and wound care services in their specific billing context.

No covered codes are enumerated in NCD 47.

No specific codes are designated as non-covered within the policy data. The non-covered modalities are described by treatment type (ultraviolet light, low intensity direct current, topical oxygen, Balsam of Peru dressings), not by code.

Related ICD-10 Diagnosis Codes: NCD 47 does not list specific ICD-10-CM diagnosis codes. The clinical context of this policy maps to pressure ulcer/pressure injury diagnosis codes; consult your MAC LCD and coding guidelines for the appropriate ICD-10-CM codes for decubitus ulcers at your facility.

What Your Billing Team Should Do