Coverage guidelines
Look to Byram Healthcare for a variety of reimbursement tools that help simplify coverage guidelines and documentation requirements.
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Documentation
The patient’s medical record must provide proper clinical justification for their dressings. All chart notes must align with the health plan’s coverage guidelines and must properly support the detailed physicians order.
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Dressing selection guide
Our Advanced Wound Dressing Selection Guide helps clarify which dressings may be covered for a specific wound.
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Non-Fixed Fee HCPCS Codes
Some dressings may not have "fixed fee" established by the health plan making their coverage and availability uncertain. Generally, most HCPCS code have a fixed fee established by CMS PDAC (pricing, data Analysis and Coding). However, some HCPCS codes are not assigned a fixed fee by PDAC. Claims for dressings associated with these HCPCS are adjudicated on a bases and require extensive documentation. These dressings may not be available due to coverage uncertainty.
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Explore our Wound care Education
Along with our product offerings, our product catalogs offer valuable insurance coverage and educational information.
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