Allevyn* Adhesive Dressing

Last updated on 11/10/22 | First published on 12/23/17 | Literature review current through Mar. 2024 [cite]

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Technology and Product Assessment

Product Type: Foam

Unbiased information for educational purposes only. WoundReference does not produce, market, advertise, re-sell or distribute healthcare goods or services consumed by, or used on patients. For information about specific products, please contact the manufacturer directly.

ALLEVYN Adhesive is a foam wound dressing.
INTENDED USES: indicated for exudate absorption and the management of partial- to full-thickness wounds. Some typical wounds are: ulcers (venous, arterial, diabetic, pressure), donor sites, surgical incisions, surgical excisions and burns (first- and second-degree).
CLAIMED FEATURES: With its triple layer formation, this product was designed with this combination to ensure optimal fluid handling to support moist wound healing. ALLEVYN Adhesive is a dressing specifically designed to manage chronic or acute exuding wounds. The triple action technology helps to maintain an optimal balance in fluid creating a moist wound environment for healing. The low allergy adhesive helps to keep the dressing securely in place without adhering to the wound. The breathable top film helps to minimize the risk of maceration to the wound and peri-wound. Provides an effective barrier function to exogenous bacteria as well as helping to prevent fluid and bacterial strikethrough. Easy to apply and remove. Conforms to body contours. Available in a wide range of sizes which can be cut to fit areas such as elbows and heels. Sacral sizes available.
OPTIONS: 3’’ x 3’’/7.5cm x 7.5cm, 10/carton

Manufacturer: Smith & Nephew, Inc.

Information retrieved from manufacturer and/or FDA-approved labels

* Wound Reference does not produce, market, re-sell or distribute health care goods or services consumed by, or used on, patients. The product information contained on this page, including the product images and additional product materials, was collected from various supplier sources. All product claims and specifications are those of the product suppliers. Every effort has been made to ensure the accuracy of the product information, however on occasion manufacturers may alter their products or packaging without notice. Wound Reference assumes no liability for inaccuracies or misstatements about products. The properties of a product may change or be inaccurate following the posting or printing of the product information in the document, either in the print or online version. Due to product changes, information listed in this document is subject to change without notice. We recommend that you always read labels, warnings and instructions for use before using a product. Content on this site is for reference purposes and is not intended to be a substitute for professional advice given by a physician or other licensed healthcare professional.

ESSENTIALS

Product

Estimated
Out-of-pocket
Cost

HCPCS Class

HCPCS

ALLEVYN Adhesive, 3’’ x 3’’/7.5cm x 7.5cm, 10/carton

Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6212

ALLEVYN Adhesive, 5’’ x 5’’/12.5cm x 12.5cm, 10/carton

Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6212

ALLEVYN Adhesive, 7’’ x 7’’/17.5cm x 17.5cm, 10/carton

Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6213

ALLEVYN Adhesive, 9’’ x 9’’/22.5cm x 22.5cm, 10/carton

Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing

A6214

ALLEVYN Adhesive, Sacrum 6 ¾’’ x 6 ¾’’/17cm x 17cm, 10/carton

Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6213

ALLEVYN Adhesive, Sacrum 9’’ x 9’’/22cm x 22cm, 10/carton

Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6213

* Hover on the information button next to each header for detailed explanation on the type of information provided by the table

Select your state for Medicare
DME coverage and co-payment

Product

Estimated
Out-of-pocket
Cost

Patient DME Co-Payment per Billable Unit

DME Reimbursement to Suppliers

Frequency Replacement if Requirements Met

Office and/or Facility - Product reimbursement

Smith & Nephew, Inc.
ALLEVYN Adhesive, 3’’ x 3’’/7.5cm x 7.5cm, 10/carton

$2.38
each dressing

$11.88

3 changes/week

Smith & Nephew, Inc.
ALLEVYN Adhesive, 5’’ x 5’’/12.5cm x 12.5cm, 10/carton

$2.38
each dressing

$11.88

3 changes/week

Smith & Nephew, Inc.
ALLEVYN Adhesive, 7’’ x 7’’/17.5cm x 17.5cm, 10/carton

$.00
each dressing (carrier discretion)

3 changes/week

Smith & Nephew, Inc.
ALLEVYN Adhesive, 9’’ x 9’’/22.5cm x 22.5cm, 10/carton

$2.52
each dressing

$12.59

3 changes/week

Smith & Nephew, Inc.
ALLEVYN Adhesive, Sacrum 6 ¾’’ x 6 ¾’’/17cm x 17cm, 10/carton

$.00
each dressing (carrier discretion)

3 changes/week

Smith & Nephew, Inc.
ALLEVYN Adhesive, Sacrum 9’’ x 9’’/22cm x 22cm, 10/carton

$.00
each dressing (carrier discretion)

3 changes/week

* Every effort has been made to ensure the accuracy of the product information, however you should visit the manufacturer's website for the latest information.

* Hover on the information button next to each header for detailed explanation on the type of information provided by the table

Product

Estimated
Out-of-pocket
Cost

Recom / Evidence

FDA Safety

Quality Measures

Cost Effectiveness

ALLEVYN Adhesive, 3’’ x 3’’/7.5cm x 7.5cm, 10/carton

Coming soon

ALLEVYN Adhesive, 5’’ x 5’’/12.5cm x 12.5cm, 10/carton

Coming soon

ALLEVYN Adhesive, 7’’ x 7’’/17.5cm x 17.5cm, 10/carton

Coming soon

ALLEVYN Adhesive, 9’’ x 9’’/22.5cm x 22.5cm, 10/carton

Coming soon

ALLEVYN Adhesive, Sacrum 6 ¾’’ x 6 ¾’’/17cm x 17cm, 10/carton

Coming soon

ALLEVYN Adhesive, Sacrum 9’’ x 9’’/22cm x 22cm, 10/carton

Coming soon

Product

Estimated
Out-of-pocket
Cost

Features

ALLEVYN Adhesive, 3’’ x 3’’/7.5cm x 7.5cm, 10/carton

Application: Can be used as primary dressing Depth: Full thickness (deep) Depth: Partial thickness (shallow) Exudate: Moderate Indications: May be applied over infected tissue Indications: May be used under compression Medicare freq of replacement: 3/week Wear time: Up to 7 days

ALLEVYN Adhesive, 5’’ x 5’’/12.5cm x 12.5cm, 10/carton

ALLEVYN Adhesive, 7’’ x 7’’/17.5cm x 17.5cm, 10/carton

ALLEVYN Adhesive, 9’’ x 9’’/22.5cm x 22.5cm, 10/carton

ALLEVYN Adhesive, Sacrum 6 ¾’’ x 6 ¾’’/17cm x 17cm, 10/carton

ALLEVYN Adhesive, Sacrum 9’’ x 9’’/22cm x 22cm, 10/carton

No CPT codes to display.

Hover on the information button next to each header for detailed explanation on the type of information provided by the table
The information provided on this website is informational only. This is not a guarantee of Reimbursement Rates, nor is it intended to make recommendations regarding clinical practices. Information on this website is subject to change with out notice due to changes in reimbursement laws, regulations, rules and policies. The ultimate responsibility for correct coding lies with the provider of services. Please contact the appropriate payer for their interpretation of the appropriate code to use for the procedure.
CPT® is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2018, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Codes referenced on Wound Reference are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage. Providers should reference the American Medical Association prior to the submission of claims for reimbursement of covered services.

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Other related brands: Mepilex Border Flex Square, 4˝ x 4˝ (10 x 10 cm), case ..., ALLEVYN Ag Gentle Border, 3” x 3”, Pack of 40, Allevyn Life: 4" x 4" (10.3cm x 10.3cm, 93cm2), 10/cart..., Mepilex Border Flex Square, 3˝ x 3˝ (7.5 x 7.5 cm), cas..., Mepilex Foam Dressing, 4˝ x 4˝ (10 x 10 cm), box of 5,..., Allevyn Heel, 1 bx/5 dressings, Allevyn Non-Adhesive Foam Wound Dressing, 4’’ x 4’’/10c..., Mepilex Border Flex Square, 6˝ x 6˝ (15 x 15 cm), case ..., AQUACEL® Foam Dressing: Adhesive, Square: 7.5x7.5cm (3"..., Allevyn Gentle Border Lite 2" x 2" (5cm x 5cm), 10 piec..., Allevyn Gentle Border Lite 4" x 4" (10cm x 10cm) 10 pie..., ALLEVYN Ag Gentle Border, 5” x 5”, Pack of 40, Allevyn Non-Adhesive Foam Wound Dressing, 2’’ x 2’’/5cm..., Allevyn Non-Adhesive Foam Wound Dressing, 6’’ x 6’’/15c..., PolyMem Non-Adhesive Dressings, 10cm x 10cm, box of 4, Allevyn Life: 6 1/16" x 6 1/16" (15.4cm x 15.4cm, 211cm..., Allevyn Non-Adhesive Foam Wound Dressing, 8’’ x 8’’/20c..., AQUACEL® Foam Dressing: Adhesive, Square: 10x10cm (4" x..., Allevyn Gentle Border Lite 3" x 3" (7.5cm x 7.5cm) 10 p..., Mepilex Foam Dressing, 4˝ x 8˝ (10 x 20 cm), box of 5,..., PolyMem Cloth Adhesive Dressings, 2.5cm x 8cm, box of 5, PolyMem Non-Adhesive Dressings, 13cm x 13cm, box of 2, Allevyn Life: 5 1/16" x 5 1/16 (12.9cm x 12.9cm, 146cm2..., Mepilex Foam Dressing, 6˝ x 6˝ (15 x 15 cm), box of 5, ..., Mepilex® Transfer, 8˝ x 20˝, Box of 4, Allevyn Gentle Border Lite 2 1/2" x 4 3/4" (5.5cm x 12c..., PolyMem Cloth Adhesive Dressings, 2" x 2", box of 20, Mepilex - Soft and conformable foam dressing: 8˝ x 20˝ ..., AQUACEL® Foam Dressing: Adhesive, sacral: 20x17.5cm (8"..., Allevyn Life: Heel Heel 9in x 9 1/8in (25cm x 25.2cm, 5..., Mepilex® Transfer, 6˝ x 8˝, Case of 40, PolyMem Non-Adhesive Dressings, 17cm x 19cm, box of 2, Allevyn Life: Sacrum 8 ½in x 9in (21.6cm x 23cm, 386cm2..., PolyMem Non-Adhesive Dressings, 10cm x 32cm, box of 1, Allevyn Life: Sacrum 6¾in x 6 7/8in (17.2cm x 17.5cm, 2..., Tegaderm High Performance Foam Adhesive Dressing, Small..., ComfortFoam Self-Adherent Soft Silicone Foam Dressing, ..., PolyMem Cloth Adhesive Dressings, 5cm x 10cm, box of 5, Dimora Sacrum Silicone Foam Dressing With Border, 6"x6"..., Mepilex Border Flex Square, 6˝ x 8˝ (15 x 20 cm), case ..., ComfortFoam Self-Adherent Soft Silicone Foam Dressing, ..., Dimora Silicone Foam Dressing With Border, 4"x4". box o..., Allevyn Gentle Border Lite 6" x 6" (15cm x 15cm) 10 pie..., Kendall™ AMD Antimicrobial Foam Dressings, 4 in. x 4 in..., PolyMem Non-Adhesive Dressings, 10cm x 61cm, box of 2, Mepilex Foam Dressing,, 8˝ x 8˝ (20 x 20 cm), box of 5,..., Kendall™ AMD Antimicrobial Foam Dressings, 4 in. x 8 in..., Kendall™ AMD Antimicrobial Foam Dressings, 6 in. x 6 in..., Kendall™ AMD Antimicrobial Foam Dressings, 8 in. x 8 in..., Advazorb, 3.9” x 3.9”, Pack of 10, AQUACEL® Foam Dressing: Adhesive, Square: 12.5x12.5cm (...,

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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

Topic 672 Version 1.0

Allevyn* Adhesive Dressing

Allevyn* Adhesive Dressing

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