Benefit Category
Drugs and Biologicals
Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
Item/Service Description A platelet-derived formula containing growth factors intended to treat nonhealing wounds (e.g., Procuren) is provided through hospital-based outpatient facilities as part of comprehensive wound- care programs designed to treat patients with chronic nonhealing wounds. It is usually applied at first in the presence of a physician, with the patient continuing applications at home.
Indications and Limitations of Coverage There is a lack of sufficient published data to determine the safety and efficacy of the platelet-derived wound healing formula (based on a technology review by the Public Health Service). Therefore, it is not covered under Medicare because it is not considered reasonable and necessary within the meaning of §1862(a)(1) of the Act.
Claims Processing Instructions
