Acknowledgement:

Information on reimbursement in the United States is provided as a courtesy. Due to the rapidly changing nature of the law and Medicare payment policy, and our reliance on information provided by outside sources, the information provided herein does not constitute a guarantee or warranty by Smith and Nephew,Inc that reimbursement will be received.

This information is provided "AS IS" and without any other warranty or guarantee, expressed or implied, as to completeness or accuracy or otherwise. This information has been compiled based on data gathered from many primary and secondary sources, including the American Medical Association and certain Medicare contractors.

Physicians and other providers must confirm or clarify coding and coverage from their respective payers, as each payer may have differing formal or informal coding, coverage policies, or decisions. Physicians and providers are responsible for accurate documentation of patient conditions, and for reporting of procedures and products in accordance with particular payer requirements.

Reimbursement


Coverage Guidelines

Medicare Coverage

Medicare does not have a National Coverage Determination (NCD) regarding the use of OASIS® Matrix products. Therefore, coverage is based on local Medicare contractor decisions and can vary between jurisdictions/states.

Over the past 11 years, the clinical and regulatory information for OASIS® Wound Matrix has been reviewed by nearly all Medicare medical directors, resulting in positive or neutral Medicare coverage in all states, plus American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands.

In the last year, Smith & Nephew has used the LCD Reconsideration Process to request coverage for OASIS® Ultra Tri-Layer Matrix, resulting in positive or neutral Medicare coverage by 7 of the 8 contractors. Monitor your contractor's LCD for its coverage decision.

Qualified healthcare professionals (QHPs) should frequently check their respective Medicare contractor's website to determine if the contractor has released any draft/final LCDs, articles, or bulletins regarding the use of OASIS® Matrix products.

  • If your Medicare contractor has written an LCD, article, or bulletin pertaining to OASIS® Matrix products, you should review the indications and limitations of coverage and the medical necessity, coding, utilization, and documentation guidelines
  • QHPs should obtain an Advance Beneficiary Notice (ABN) of noncoverage in cases where they believe Medicare coverage will be denied on reasonable and necessary grounds under Medicare coverage policies
  • If your Medicare contractor has not written an LCD, article, or bulletin regarding OASIS® Matrix products, the application and product may be covered based upon medical necessity. In those cases, you should follow the package insert and the American Medical Association and Medicare coding and documentation guidelines to support the medical necessity of OASIS® Wound Matrix and OASIS® Ultra Tri-Layer Matrix

OASIS® is a registered trademark of Cook Biotech, Inc.




©2015 Smith & Nephew, Inc. All rights reserved.
OASIS is a registered trademark of Cook Biotech, Inc.
All trademarks acknowledged. HS1187-0214

Use of this Website is governed by the Terms of Use and Copyright & Disclaimer and Privacy Policy. This Website is intended for healthcare professionals in the United States only. The information provided is for informational purposes only and is not intended to be medical advice. It does not replace the professional training, experience, and knowledge of the healthcare provider responsible for patient care, who must base treatment upon the unique characteristics of each patient.

If you have questions about OASIS® MATRIX products that are not answered by this Website, contact us.