MED.00110 Silver-based Products for Wound and Soft Tissue Applications

This policy addresses antimicrobial silver wound dressings (e.g., Acticoat, Actisorb, Silversorb) for wound and soft tissue applications. Anthem deems these products investigational/experimental and not medically necessary; therefore, they are not covered for any indication. There are no covered uses, and related services/supplies (e.g., CPT/HCPCS codes 00132, 20999, A4649, G0460, Q4200, Q4226, S0157, S9055) are considered non-covered as investigational.

"Antimicrobial silver wound dressings, (for example, Acticoat, Actisorb, and Silversorb) are consideredinvestigational and not medically necessaryfor all applications."

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