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Reimbursement

Reimbursement Manual

Section I:

Wound Care Products

Coverage and Payment Rules

Medicare Part B

A. Coverage Criteria 3

B. Debridement Criteria 3

C. Qualifying Wounds 3

D. Non-Qualifying Wounds 3

E. Payment Rules 4

F. Coverage Rules 4

G. Documentation Requirements 4

H. Individual Consideration Products 5

I. Coding Verification 6

Composite Dressings 7

Transparent Film Dressings 8

Hydrocolloid Dressings 9

Gauze, Non-Impregnated 10

Foam Dressings 11

Alginate Dressings 13

Alginate Wound Fillers 13

Wound Fillers 14

Contact Layer Dressings 15

Specialty Absorptive Dressings 16

Tapes 18

Silicone Gel Sheets 18

Hydrogel Dressings 19

Hydrogel Wound Fillers 20

Miscellaneous 21

Skin Care Products 22

IV Care Products 24

Section II:

Ostomy Skin Care Products

Coverage and Payment Rules

Medicare Part B

A. Coverage Criteria 25

B. Payment Rules 25

C. Coverage Rules 25

D. Documentation Requirements 25

Ostomy Supplies/Skin Preps/Solvents 26

Section III:

Drugs, Biologicals and Devices

Medicare Part B

A. Coverage Criteria for Medicare Part B 27

B. Reimbursement of Drugs, Biologicals and Devices 29

C. Coverage Criteria for Medicaid and GLADASE^◊ 31

Section IV:

Segment Reimbursement

Information 32

A. Medicare Insurance 33

B. Medicare Reimbursement Mechanisms 37

C. Medicaid and Third Party Payers Reimbursement Mechanisms 38

D. Billing for Medical Services

Section V:

Helpful Information on S&N Products

DERMAGRAFT^◊ 40

S&N Product NDC Listing 41

Section VI:

Appendices

1. DMERC Manual Reference for Surgical Supplies 42

2. DMERC Offices 56

Click here to view or print the VERSAJET^◊ Reimbursement Guide

Please click here to view or print the Reimbursement Manual for Wound, IV, Ostomy, and Skin Care Products, Medicare Part B Coverage and Payment Rules, Usual Allowable Amounts, HCPCS Codes, and Fee Schedules