Wiki Puraply

[solocoder]

OK, has anyone EVER gotten a Puraply claim paid?? We keep having it denied as experimental. For a diabetic ulcer? Really?

 

[CodingKing]

NGS Medicare i believe covers it. I found a press release from late 2016

https://www.massbio.org/news/member...or-medicare-reimbursement-in-10-states-124967

Blue Cross for example does not:

With the exception of products used within the scope of FDA indications for treatment of burns and rare skin conditions such as recessive dystrophic epidermolysis bullosa, FDA approval for a specific use does not define that product as non-investigational. The following list of products considered investigational may not be all-inclusive:

.......
PuraPly™ Wound Matrix (previously FortaDerm™) – single layer fenestrated sheet of biocompatible porcine-derived collagen
PuraPly™ AM (Antimicrobial Wound Matrix) – collagen sheet coated with antimicrobial
........

https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/bioengineered_skin_and_tissue.pdf

Same for BCBCS KS

https://www.bcbsks.com/providers/Me...eredSkin_SoftTissueSubstitutes_2017-04-19.pdf

Only specific ones are covered by Blue Cross

Treatment of chronic, non infected, full-thickness diabetic lower-extremity ulcers using the following tissue-engineered skin substitutes may be considered medically necessary:
• AlloPatch®*
• Apligraf®**
• Dermagraft®**
• Integra® Dermal Regeneration Template

NOTE: applications will be limited to no more than the following weekly applications per wound when the criteria above are met:

o Apligraf: 4 applications
o Dermagraft: 8 applications