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FlowerDerm™ Acellular Dermal Allograft

FlowerDerm™ Acellular Dermal Allograft

FlowerDerm™ Acellular Dermal Allograft


How supplied

  • FDM 011: FlowerDerm (Standard or Non-Meshed), Thin, 1x1cm
  • FDM 012: FlowerDerm (Standard or Non-Meshed), Thin, 1x2cm
  • FDM 024: FlowerDerm (Standard or Non-Meshed), Thin, 2x4cm
  • FDM 101: FlowerDerm (Standard or Non-Meshed), Medium, 1x1cm
  • FDM 102: FlowerDerm (Standard or Non-Meshed), Medium, 1x2cm
  • FDM 112: FlowerDerm (Standard or Non-Meshed), Medium, 1x12cm
  • FDM 204: FlowerDerm (Standard or Non-Meshed), Medium, 2x4cm
  • FDM 404: FlowerDerm (Standard or Non-Meshed), Medium, 4x4cm
  • FDM 408: FlowerDerm (Standard or Non-Meshed), Medium, 4x8cm
  • FDM 505: FlowerDerm (Standard or Non-Meshed), Medium, 5x5cm
  • FDM 510: FlowerDerm (Standard or Non-Meshed), Medium, 5x10cm
  • FDM 498: FlowerDerm (Standard or Non-Meshed), Thick, 4x8cm
  • FDM 595: FlowerDerm (Standard or Non-Meshed), Thick, 5x5cm
  • FDM 590: FlowerDerm (Standard or Non-Meshed), Thick, 5x10cm


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:

  • CY 2019: low cost

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


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". 

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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 754 Version 1.0