Transcription of Clinical Policy Bulletin: Wound Care - Aetna Medicaid
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Wound care Page 1 of 96 01/28/2015 Clinical Policy bulletin : Wound care Revised February 2015 Number: 0244 (Replaces CPB 331) Policy I. Aetna considers the following products for Wound care medically n ecessary according to the criteria indicat A. Apligraf (graftskin) Aetna considers a culture-derived human skin equivalent (HSE) called Apligraf (graftskin) medically necessary for any of the following indications: 1. F or u se with standard diabetic foot ulcer care for the treatment of full-thickness neuropathic di fo ot ulcers of greater than 3-weeks duration that have not a dequately responded to conventio therapy a nd which extend through the dermis but without tendon, muscle, capsule or bone ex or 2.
Wound Care Page 1 of 96 ... Clinical Policy Bulletin: Wound Care . Revised February 2015 . Number: 0244 (Replaces CPB 331) Policy. I. Aetna considers the following producfor ts wound care medically necessary according to the criteria indicat. A. Apligraf (graftskin)
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