Apligraf® commercial insurance coverage support.
When it comes to treating VLUs and DFUs, 100% of commercial medical policies cover Apligraf.*1 The commercial payer summary guidelines below show what the policies are for a number of insurance providers.
Commercial insurance coverage
100%
of commercial medical policies cover Apligraf treatment for VLUs and DFUs*1
Commercial payer summary guidelines
Aetna Wound Care Policy #0244
Effective: 05/28/1998
Last Review: 07/29/2022
Source: http://www.aetna.com/cpb/medical/data/200_299/0244.html
Anthem Medical Coverage Policy #SURG 00011
Allogeneic, Xenographic, Synthetic and Composite Products for Wound Healing and Soft Tissue Grafting
Effective: 06/29/2022
Last Review: 05/12/2022
Source: https://www.anthem.com/dam/medpolicies/abcbs/active/policies/mp_pw_a053309.html
†Only Grafix Prime is covered for DFUs.
BC/BS Federal Employee Program
Bioengineered Skin and Soft Tissue Substitutes Policy #FEP7.01.113
Effective 04/01/2022
Amniotic Membrane and Amniotic Fluid Policy #FEP 7.01.149
Effective: 07/01/2022
Sources: https://www.fepblue.org/-/media/PDFs/Medical%20Policies/3-18-2022/Medical_Policies/701113%20Bioengineered%20Skin%20and%20Soft%20Tissue.pdf
https://www.fepblue.org/-/media/PDFs/Medical%20Policies/07-06-2022/701149%20Amniotic%20Membrane%20and%20Amniotic.pdf
BC/BS Highmark Commercial Medical Policy—Pennsylvania #S-33-035 & #S-249-007
Effective: 01/01/2021
Last Review: 12/21/2020
Sources: https://securecms.highmark.com/content/medpolicy/en/highmark/pa/commercial/policies/Surgery/S-33/S-33-035.html
https://securecms.highmark.com/content/medpolicy/en/highmark/pa/commercial/policies/Surgery/S-249/S-249-007.html
Cigna Medical Policy #0068
Tissue-Engineered Skin Substitutes
Effective: 05/15/2022
Next Review: 03/15/2023
Source: https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0068_coveragepositioncriteria_woundhealing.pdf
Excellus Medical Coverage Policy #7.01.35
Bioengineered Tissue Products for Wound Treatment and Surgical Interventions
Effective: 04/15/2021
Source: https://provider.excellusbcbs.com/documents/20152/127121/bioengineered-tissue-products.pdf/ae9812e6-205c-a3a3-4377-c1e367687672?t=1563463233746
Humana Medical Policy #HCS-0370-039
Skin and Tissue Substitutes
Effective: 06/23/2022
Last Review: 01/27/2022
Source: https://dctm.humana.com/Mentor/Web/v.aspx?objectID=0900092982efa7d9&searchID=79c54fc6-5303-4a02-9b7f-23facd9744fe&dl=1
‡Grafix Core and Grafix Prime.
Medica Tissue-Engineered Skin Substitutes for Wound and Surgical Care
Effective: 02/16/2022
Source: https://partner.medica.com/-/media/documents/provider/coverage-policies/tissue-engineered-skin-substitutes-cp.pdf?la=en
United Health Care Commercial Medical Policy #2020T0592H
Effective: 07/01/2022
Source: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/skin-soft-tissue-substitutes.pdf
Ready to help your VLU and DFU patients?
Talk to an Organogenesis Tissue Regeneration Specialist about using Apligraf, the gold standard to heal VLUs and DFUs faster.
Contact usPlease refer to the Apligraf Package Insert for complete prescribing information.
The coverage information provided shall not be construed as a statement, promise, or guarantee that reimbursement will be received. Reimbursement requirements are subject to change at any time. Check with your local payer regularly.
*Insurance coverage varies by payer and is subject to change at any time. Confirm with your current applicable payer policies for up-to-date Apligraf coverage requirements and policies.
EpiFix is a registered trademark of MiMedx Group Inc.
Grafix is a registered trademark of Osiris Therapeutics, Inc.
TheraSkin is a registered trademark of Solsys Medical, LLC.
REFERENCE:
- Data on file. Organogenesis Inc.