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


Private Payer and Medicaid Coverage

Private payers and Medicaid vary in their coverage guidelines and payment rates. Therefore, qualified healthcare professionals (QHPs) should verify the patient's insurance benefits before applying OASIS® Matrix products. If the procedure and the product are covered on the patient's benefits, verify if prior authorization is required.

OASIS® Wound Matrix is now covered by a majority of private payers.

Now that OASIS® Ultra Tri-Layer Matrix has been assigned a unique HCPCS code, Smith & Nephew is working to have it added as a covered product on the same private payer policies that now cover OASIS® Wound Matrix.

NOTE:

  • Some private payers and/or Medicaid may require prior authorization and/or predetermination before approving the application of an OASIS® Matrix product
  • Prior to application, QHPs should verify private payer and Medicaid codes, coverage, and documentation requirements for each patient
  • If you need assistance with insurance benefits verification and/or prior authorization requirements for the application of OASIS® Matrix products, please contact the OASIS® Matrix Products Reimbursement Guidance Center Hotline at 1-877-805-5005
  • If private payers deny coverage for an OASIS® Matrix product because they deem it to be "experimental" or "investigational," QHPs should supply the payer's medical director with the published information to support the medical necessity of the OASIS® Matrix product

 

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.