Last updated on 11/10/22 | First published on 1/30/18 | Literature review current through Feb. 2023
[cite]
For full access to this topic and more
premium content, upgrade today. Or browse to enjoy free content and tools.
CODING, COVERAGE AND REIMBURSEMENT
This section currently focuses primarily on Medicare. It may be expanded in the future to include information on private insurers as well.
Medicare hospital outpatient prospective payment system (OPPS) cost category assignment:
Frequency of replacement allowed by Medicare:

Medicare Administrative Contractor (MAC) |
Frequency of replacement if requirements met |
Novitas Solutions, Inc. |
Not routinely covered |
CGS Administrators, LLC |
Not routinely covered
|
Palmetto |
10 units in 12 weeks |
First Coast Service Options, Inc. (FCSO) |
1 type of product per 12 weeks, fewest repeat applications and amount of product is expected
|
Noridian
Wisconsin Physicians Service Insurance Corporation (WPS)
National Government Services, Inc. (NGS)
|
Carrier discretion
|
More details on requirements, medical necessity and documentation in specific Medicare Local Coverage Determinations (if available). See section on Coding, Coverage and Reimbursement in topic "Cellular and/or Tissue Products".
Official reprint from WoundReference® woundreference.com ©2023 Wound Reference, Inc. All Rights Reserved
Use of WoundReference is subject to the
Subscription and License Agreement.
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.