The Wound Camera Seven MACs Proposed to Stop Paying For

Seven Medicare contractors wrote the same coverage policy last week.

There are only seven.

On October 1 the Medicare Coverage Database took in 16 proposed local coverage determinations, every one of them opening a comment period that day and closing it on November 14. Fourteen of the sixteen propose non-coverage.

Twelve are wound care. Seven of those twelve are the same draft, filed by Noridian, Palmetto, CGS, WPS, Novitas, First Coast and Wellpoint Federal, which is the complete roster of organizations holding A/B MAC coverage authority.

And fluorescence wound imaging is the only one of the five topics with no final LCD on it anywhere in the country, in either direction (chart below).

The camera nobody ever wrote a rule about

The drafts are DL40413 (Novitas), DL40415 (First Coast), DL40437 (WPS), DL40439 (Wellpoint), DL40441 (Noridian), DL40443 (Palmetto) and DL40468 (CGS). All seven are flagged contractor-initiated in the tracking sheets rather than requested from outside.

The determination runs the same in each: real-time fluorescence wound imaging for locating bacterial wound pathogens, for bacterial load above 10,000 CFU/g, and for measurement of wound size "with or without clinical darkness" is noncovered under 1862(a)(1)(A).

The evidence section does not hedge about whose device this is. It names MolecuLight.

Eight diagnostic-accuracy studies, sample sizes from 14 to 178, three disclosing industry funding or conflicts, graded through QUADAS 2 and landing at very low certainty. None of IDSA, WOCN, IWGDF, SVS or AAFP recommends routine use.