Polymem Adhesive Cloth Adhesive Dressings

Last updated on 11/10/22 | First published on 10/12/21 | Literature review current through Oct. 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.

Description: Polymem Adhesive Strip is a foam dressing.

INTENDED USES: Light-moderate draining wounds: Venous Stasis Ulcers, Pressure Ulcers, Arterial Ulcers, Diabetic/Neuropathic Ulcers, Surgical Wounds, Dermal Wounds, Burns, Trauma Wounds

CLAIMED BENEFITS: Bacterial Barrier, Absorbs, Cleanses. Polyurethane membrane matrix on a

semipermeable thin film backing. The hydrophilic layer contains a super absorbent starch co-polymer. The dressing contains F68 surfactant and glycerin.

OPTION: 1" x 3", case of 100

Manufacturer: Ferris Mfg. Corp.

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

PolyMem Cloth Adhesive Dressings, 2.5cm x 8cm, box of 5

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

A6212

PolyMem Cloth Adhesive Dressings, 2" x 2", box of 20

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

A6212

PolyMem Cloth Adhesive Dressings, 5cm x 10cm, box of 5

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

A6212

* 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

Ferris Mfg. Corp.
PolyMem Cloth Adhesive Dressings, 2.5cm x 8cm, box of 5

$2.38
each dressing

$11.88

3 changes/week

Ferris Mfg. Corp.
PolyMem Cloth Adhesive Dressings, 2" x 2", box of 20

$2.38
each dressing

$11.88

3 changes/week

Ferris Mfg. Corp.
PolyMem Cloth Adhesive Dressings, 5cm x 10cm, box of 5

$2.38
each dressing

$11.88

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

PolyMem Cloth Adhesive Dressings, 2.5cm x 8cm, box of 5

Coming soon

PolyMem Cloth Adhesive Dressings, 2" x 2", box of 20

Coming soon

PolyMem Cloth Adhesive Dressings, 5cm x 10cm, box of 5

Coming soon

Product

Estimated
Out-of-pocket
Cost

Features

PolyMem Cloth Adhesive Dressings, 2.5cm x 8cm, box of 5

Application: Can be used as primary dressing Application: Can be used as secondary dressing Depth: Full thickness (deep) Depth: Partial thickness (shallow) 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

PolyMem Cloth Adhesive Dressings, 2" x 2", box of 20

PolyMem Cloth Adhesive Dressings, 5cm x 10cm, box of 5

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, Mepilex Border Flex Square, 3˝ x 3˝ (7.5 x 7.5 cm), cas..., Allevyn Life: 4" x 4" (10.3cm x 10.3cm, 93cm2), 10/cart..., Mepilex Foam Dressing, 4˝ x 4˝ (10 x 10 cm), box of 5,..., Allevyn Non-Adhesive Foam Wound Dressing, 4’’ x 4’’/10c..., Allevyn Heel, 1 bx/5 dressings, Allevyn Gentle Border Lite 2" x 2" (5cm x 5cm), 10 piec..., ALLEVYN Adhesive, 3’’ x 3’’/7.5cm x 7.5cm, 10/carton, Allevyn Gentle Border Lite 4" x 4" (10cm x 10cm) 10 pie..., AQUACEL® Foam Dressing: Adhesive, Square: 7.5x7.5cm (3"..., Mepilex Border Flex Square, 6˝ x 6˝ (15 x 15 cm), case ..., PolyMem Non-Adhesive Dressings, 10cm x 10cm, box of 4, ALLEVYN Ag Gentle Border, 5” x 5”, Pack of 40, AQUACEL® Foam Dressing: Adhesive, Square: 10x10cm (4" x..., Allevyn Non-Adhesive Foam Wound Dressing, 2’’ x 2’’/5cm..., Mepilex Foam Dressing, 6˝ x 6˝ (15 x 15 cm), box of 5, ..., Mepilex® Transfer, 6˝ x 8˝, Case of 40, Allevyn Life: 6 1/16" x 6 1/16" (15.4cm x 15.4cm, 211cm..., Allevyn Non-Adhesive Foam Wound Dressing, 6’’ x 6’’/15c..., Allevyn Non-Adhesive Foam Wound Dressing, 8’’ x 8’’/20c..., Allevyn Life: 5 1/16" x 5 1/16 (12.9cm x 12.9cm, 146cm2..., Allevyn Life: Sacrum 6¾in x 6 7/8in (17.2cm x 17.5cm, 2..., Allevyn Gentle Border Lite 3" x 3" (7.5cm x 7.5cm) 10 p..., PolyMem Non-Adhesive Dressings, 13cm x 13cm, box of 2, ALLEVYN Adhesive, 5’’ x 5’’/12.5cm x 12.5cm, 10/carton, Mepilex Foam Dressing, 4˝ x 8˝ (10 x 20 cm), box of 5,..., Allevyn Gentle Border Lite 2 1/2" x 4 3/4" (5.5cm x 12c..., Allevyn Life: Heel Heel 9in x 9 1/8in (25cm x 25.2cm, 5..., Allevyn Life: Sacrum 8 ½in x 9in (21.6cm x 23cm, 386cm2..., PolyMem Non-Adhesive Dressings, 17cm x 19cm, box of 2, AQUACEL® Foam Pro adhesive sacral: 20x16.9cm (8" x 6¾"), Mepilex - Soft and conformable foam dressing: 8˝ x 20˝ ..., PolyMem Non-Adhesive Dressings, 10cm x 32cm, box of 1, Mepilex® Transfer, 8˝ x 20˝, Box of 4, AQUACEL® Foam Dressing: Adhesive, sacral: 20x17.5cm (8"..., AQUACEL® Foam Dressing: Adhesive, Square: 12.5x12.5cm (..., Mepilex Border Flex Square, 6˝ x 8˝ (15 x 20 cm), case ..., Cutimed Siltec Sacrum, 17.5 cm x 17.5 cm, pack of 5, Dimora Silicone Foam Dressing With Border, 6"x6", box o..., Mepilex Border Flex, 3 X 3 Inch With Border Film Backin..., Kendall™ AMD Antimicrobial Foam Dressings, 4 in. x 8 in..., Kendall™ AMD Antimicrobial Foam Dressings, 4 in. x 4 in..., Kendall™ AMD Antimicrobial Foam Dressings, 8 in. x 8 in..., Dimora Silicone Foam Dressing With Border, 4"x4". box o..., PolyMem Non-Adhesive Dressings, 10cm x 61cm, box of 2, ComfortFoam Self-Adherent Soft Silicone Foam Dressing, ..., Biatain Silicone Lite, 2x2 inch, box of 5, ComfortFoam Self-Adherent Soft Silicone Foam Dressing, ..., Mepilex Foam Dressing,, 8˝ x 8˝ (20 x 20 cm), box of 5,..., Advazorb, 3.9” x 3.9”, Pack of 10,

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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 1681 Version 1.0

Polymem Adhesive Cloth Adhesive Dressings

Polymem Adhesive Cloth Adhesive Dressings

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