Noridian Issues a Clarification Notice About Updated Collagen Dressings Coverage
Prior to the latest LCD changes, DME providers who dispensed collagen for patients at-home use, could only receive coverage for full-thickness wounds. Since the middle of 2017, however, the guidelines for coverage have been amended.
Collagen is now covered for three wound types:
- Full-thickness wounds
- Wounds with light to moderate exudate
- Wounds that have stalled or not progressed toward a healing goal.
Each wound type is independent of each other and an individual one can justify coverage.
The LCD states that collagen can stay in place up to seven days depending on the product type. However, that does not impose a one dressing per week limitation and the collagen dressings can be changed as frequently as needed based on the condition being treated as well as the clinical judgement of the treating physician. Product information is requested in the narrative section of the claim as it will be used to determine the appropriate change frequency based on the manufacturers recommendations and the PDAC guidelines.
Noridian DME Outreach and Education
NORIDIAN HEALTHCARE SOLUTIONS LLC
What does this mean?
Noridian (Jurisdiction A & D) and Cigna (Jurisdiction B&C) will cover the use of Collagen Powder or Collagen Matrix (Pads) for use on:
- Full-thickness wounds,
- Wounds with light to moderate exudate, or
- Wounds that have stalled or not progressed towards a healing goal.
This is the only Surgical Dressing listed in the LCD that does not require a full-thickness wound for DME coverage.
When does this go into effect?
The LCD went into effect 7/27/2017.
Where is this information located?
The LCD explaining the coverage rules can be found online at CMS.gov.
DME Jurisdiction Map
Click on map to view larger size
Jurisdiction A
Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.
Jurisdiction B
Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin.
Jurisdiction C
Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, West Virginia and the US Virgin Islands.
Jurisdiction D
Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington and Wyoming
AMERX Health Care Corp.
Founded in 1993 by John C. Anderson, AMERX Health Care Corporation is dedicated to providing superior wound and skin care products that deliver positive outcomes, increase patient compliance, and reduce treatment costs. Long-known for the top-rated AMERIGEL® line of topical wound and skin care products featuring Oakin® (oak extract), AMERX Health Care has expanded our offerings throughout the years. We now offer a comprehensive suite of wound care products including HELIX3® Bioactive Collagen, AMERX® Kits & Dressings, and the innovative EXTREMIT-EASE® Compression Garment.
