What Are Pressure Ulcers (Bed Sores)?

A pressure ulcer, also known as a bed sore or decubitus ulcer, is a wound that develops when prolonged pressure damages the skin and underlying tissue.
These wounds are common in:

• Patients with limited mobility
• People who spend extended time in bed
• Wheelchair users
• Older adults with certain medical conditions

Pressure ulcers typically form on areas where bone is close to the skin:

• Lower back (sacrum)
• Hips
• Heels
• Elbows
• Shoulder blades

Why Pressure Ulcers Develop

Pressure ulcers occur when:

• Continuous pressure reduces blood flow to an area of skin
• The skin and underlying tissue don’t receive enough oxygen and nutrients
• Tissue begins to break down and die
• An open wound forms

Risk factors include:

• Immobility or limited movement
• Incontinence
• Poor nutrition
• Advanced age
• Certain medical conditions (diabetes, spinal cord injury)

Stages of Pressure Ulcers

Pressure ulcers are classified into stages based on severity:

Stage 1: Skin is intact but red and may not blanch (turn white) when pressed

Stage 2: Partial skin loss with blistering or shallow open wound

Stage 3: Full-thickness skin loss with deeper tissue damage

Stage 4: Severe tissue damage affecting muscle, bone, or supporting structures

Unstageable: Wound covered with dead tissue (eschar) that prevents staging

Advanced-stage pressure ulcers (Stage 3-4) require specialized wound care treatment.

Complications of Untreated Pressure Ulcers

Without proper treatment, pressure ulcers can lead to:

• Infection (cellulitis, osteomyelitis, sepsis)
• Hospitalization
• Extended recovery times
• Reduced quality of life
• Serious health complications

Early intervention is critical to preventing these complications.

Treatment Options for Non-Healing Pressure Ulcers

Treatment for pressure ulcers depends on the stage and severity of the wound.
A wound care specialist will develop a personalized treatment plan.

Prevention and Early Care

For Stage 1-2 pressure ulcers:

• Regular position changes (every 2 hours)
• Pressure-relieving devices (special mattresses, cushions)
• Skin care and moisture management
• Nutrition support
• Treatment of underlying conditions

Advanced Wound Care (Stage 3-4)

For advanced-stage pressure ulcers that are not healing with standard care,
specialized treatments may include:

• Debridement: Removal of dead or infected tissue to promote healing
• Advanced wound dressings: Antimicrobial, moisture-wicking, or specialized dressings
• Negative pressure wound therapy (NPWT): Vacuum-assisted closure to promote healing
• Infection management: Antibiotics and infection control
• Biologic treatments: Tissue grafts or biologic materials to support tissue regeneration

Biologic Wound Treatments for Pressure Ulcers

Biologic materials (such as amniotic tissue allografts) may be recommended when:

• The pressure ulcer is Stage 3 or 4
• Standard treatments have not achieved adequate healing
• The wound is at risk of serious complications
• A physician determines they are medically appropriate

These materials are designed to:

• Reduce inflammation and infection risk
• Promote tissue regeneration
• Support the body’s natural healing process
• Reduce hospitalization and complications

Surgical Options

For severe pressure ulcers, surgical intervention may be considered, including:

• Surgical debridement (removal of dead tissue)
• Flap procedures (tissue transfer from another area)
• Reconstruction surgery

Your wound care team will discuss whether surgery is appropriate for your situation.

Medicare Part B Coverage for Pressure Ulcer Treatment

Medicare Part B may cover certain advanced wound care treatments for pressure ulcers,
including biologic grafts, when a qualified healthcare provider determines they are medically necessary.

What Medicare Part B May Cover

Potential coverage includes:

• Evaluation and management by a wound care specialist
• Advanced wound dressings
• Negative pressure wound therapy (NPWT)
• Biologic wound coverings such as human tissue grafts (when medically necessary)
• Infection management and antibiotic therapy
• Related supplies and equipment

Eligibility Requirements

To qualify for Medicare coverage, you typically must have:

• Active Medicare Part B coverage
• A pressure ulcer that meets Medicare’s medical necessity criteria
• Documentation from a qualified healthcare provider
• Evidence that standard treatments have been tried or are not appropriate

How Coverage is Determined

Your healthcare provider will:

1. Evaluate your pressure ulcer

2. Review your medical history and treatment history

3. Determine if advanced treatment is medically necessary

4. Submit documentation to Medicare

5. Receive a coverage determination from Medicare

Your Out-of-Pocket Costs

If Medicare approves your treatment, your costs may include:

• The Medicare Part B deductible (if it has not yet been met for the year)
• Medicare Part B coinsurance (typically about 20% of the Medicare-approved amount)
• Any services or supplies not covered by Medicare

Actual costs depend on your specific Medicare coverage and the treatments determined by your healthcare provider.

When to Seek Professional Wound Care for Pressure Ulcers

Seek immediate professional care if you have:

• A pressure ulcer that is not improving after 1-2 weeks
• Signs of infection (redness, warmth, drainage, odor, fever)
• Increasing pain or swelling
• A Stage 3 or 4 pressure ulcer
• Multiple pressure ulcers

Early evaluation by a wound care specialist can significantly improve outcomes and prevent complications.