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Reimbursement Fundamentals

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DFUs
Partial or full-thickness
diabetic extremity ulcers

  • Payment is based on invoice price

  • Claims reimbursed in physician’s office at established rate (WAC pricing)

  • All amniotic tissues are listed with CMS as wound care products

  • MAC Coverage decision is based on Medical Necessity

Image by Patty Brito
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VLUs
Partial or full- thickness
venous insufficiency ulcers

Not listed on any skin substitute policies Coverage is based on medical necessity and pre-authorization is recommended

Benefits

  • Positive reimbursement for appropriate patients with minimal/no secondary

  • Flexibility with process (ASP, Rebate)

  • Multiple sizes available to adapt to the treatment protocol

  • Versatile with convenient “off the shelf” stability

  • Example : WITHOUT CPT code included

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