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 01/27/2020

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 12/27/2018
Last review 11/7/2019

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 4/1/2019

Source: https://media.fepblue.org/-/media/51DFFDD5B91F47D3930E7DD60E0DE12C.pdf

BC/BS Highmark Commercial Medical Policy—Pennsylvania #S-33-032 & #S-249-004

Effective 1/1/2019
Last Review 9/2019

Sources: https://securecms.highmark.com/content/medpolicy/en/highmark/pa/commercial/policies/Surgery/S-33/S-33-032.html https://securecms.highmark.com/content/medpolicy/en/highmark/pa/commercial/policies/Surgery/S-249/S-249-004.html

Cigna Medical Policy #0068

Tissue-Engineered Skin Substitutes

Effective 2/15/19
Last review 2/15/20

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 1/17/2002
Last review 6/20/2019

Source: https://provider.excellusbcbs.com/documents/20152/127121/bioengineered-tissue-products.pdf/ae9812e6-205c-a3a3-4377-c1e367687672?t=1563463233746

Humana Medical Policy #HCS-0370-033

Skin and Tissue Substitutes

Effective 1/28/2020
Last review 1/28/2020

Source: http://apps.humana.com/tad/tad_new/Search.aspx?criteria=Apligraf&searchtype=freetext&policyType=both Grafix Core and Grafix Prime.

Medica Tissue-Engineered Skin Substitutes for Wound and Surgical Care

Effective 3/20/2019

Source: https://www.medica.com/-/media/documents/provider/coverage-policies/tissue-engineered-skin-substitutes-cp.pdf?la=en&hash=88B3106F02751422864FA4936BC00332

United Health Care Commercial Medical Policy #2020T0592G

Effective 1/1/2020

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.

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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:

  1. Data on file. Organogenesis Inc.