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Letter of Medical Necessity - Apligraf
- https://apligraf.com/pdf/Reimbursement-Sample-Letter-of-Medical-Necessity.pdf
- with Apligraf®, which is a bilayered skin substitute used to treat diabetic foot/venous stasis ulcers. The patient’s medical history is as follows: Apligraf was approved by the FDA for the treatment of venous stasis ulcers on May 22, 1998, and approved for the treatment of …
Skin and Soft Tissue Substitutes - Medical Clinical Policy …
- https://www.aetna.com/cpb/medical/data/200_299/0244.html
- Apligraf (graftskin): HCPCS codes covered if selection criteria are met: Q4101: Apligraf, per sq cm: ICD-10 codes covered if selection criteria are met: E08.621: Diabetes mellitus …
Apligraf® Living Cellular Skin Substitute
- https://apligraf.com/
- Apligraf® Living Cellular Skin Substitute Bioengineered with living cells to transform wounds from chronic to acute, Apligraf is a skin substitute that's backed by extensive, reliable, …
663 Bioengineered Skin and Soft Tissue Substitutes
- https://www.bluecrossma.com/common/en_US/medical_policies/663%20Bioengineered%20Skin%20and%20Soft%20Tissue%20Substitutes%20prn.pdf
- The above medical necessity criteria MUST be met for the following codes to be covered for Commercial Members: Managed Care (HMO and POS), PPO, Indemnity, Medicare …
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