Q4228, Bionextpatch, per square centimeter
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Indication: Non-healing diabetic wounds are defined as <20% reduction in wound area after at least 2 weeks of standard wound care.
- Coverage scope: Policy covers amniotic/placental products that do not require FDA approval or clearance.
- Indication: Non-healing diabetic wounds are defined as <20% reduction in wound area after at least 2 weeks of standard wound care.
- Coverage scope: Policy covers amniotic/placental products that do not require FDA approval or clearance.
- Indication: Non-healing diabetic wounds are defined as <20% reduction in wound area after at least 2 weeks of standard wound care.
- Coverage scope: Policy covers amniotic/placental products that do not require FDA approval or clearance.
4 Active Policies
BCBSIL-SUR704.011, Amniotic Membrane and Amniotic Fluid
BCBSMT-SUR704.011, Amniotic Membrane and Amniotic Fluid
BCBSNM-SUR704.011, Amniotic Membrane and Amniotic Fluid
BCBSOK-SUR704.011, Amniotic Membrane and Amniotic Fluid
Related Codes
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