Distributor Update: Medicare Change Regarding Surgical Dressings Containing Honey
Jolt #3: Healthcare Caffeine, WoundSource Edition
by Colton Mason
Medicare has recently made a significant change to several wound care dressings with honey-based components. The Medicare contractor (PDAC) which assigns reimbursement codes to wound care products made the decision to change HCPCS codes for honey-based dressings containing more than 50% medical honey to A9270. I have been working with a market leading brand in this product category, MediHoney® (Derma Sciences), to ensure everyone has the most up-to-date information regarding this recent Medicare Policy change. Here is the information that the manufacturer has compiled to help healthcare providers make educated decisions for prescribing honey-based dressings in lieu of the recent changes from Medicare:
This sudden coding change, which also changes the coverage, was issued as a policy article on January 22, 2015. This change appears to conflict with an earlier policy article, published on September 11, 2014, which specifically addressed the coding of surgical dressings containing medical honey. This decision stated that "HCPCS coding for honey containing surgical dressings will continue as it has been in the past, i.e. HCPCS coding is based upon the underlying covered components". MediHoney® dressings, in addition to other dressings containing medical honey on the market, were coded according to their substrate, i.e. alginates and hydrocolloids. However, the recent PDAC interpretation of the January 22, 2015 policy article is that if a dressing contains more than 50% medical honey it is considered non-covered.
This has resulted in the assignment of all honey dressings containing more than 50% medical grade honey to HCPCS A9270, which is a "non-covered item or service". You may begin to see notifications from some Durable Medical Equipment (DME) suppliers who have decided to no longer provide MediHoney® dressings for patients relying on Medicare Part B reimbursement for the product. The manufacturer is currently pursuing all avenues available to them to have this coding decision reversed.
Who is Affected by the Change in Reimbursement for Honey Dressings?
This change may affect only those patients who receive a prescription for home use without assistance from a Home Health Agency and the Skilled Nursing Facility residents after 100 days. However, some DME suppliers have made the decision to continue to offer MediHoney® to all patients. According to the manufacturer, they believe that this will be a short-term issue which will be corrected quickly. If you would like to continue to prescribe MediHoney® and need help locating a DME supplier to provide these products to patients at home, please contact Supreme Medical's customer service department at: 1-800-461-1370 for assistance.
Most of the medical honey dressing utilization is within care settings that are not affected by this Medicare coding change. This does not affect product usage in the following sites of care: acute care inpatient, outpatient wound clinics, long term acute care hospitals, home healthcare, and skilled nursing facilities (first 100 days). As such, there should be no disruption from any distributors providing medical honey dressings into these settings.
This decision on behalf of Medicare contractors is in no way a commentary on the safety or effectiveness of medical honey dressings. Instead, the decision was based on the relative weight of honey versus – for example – the light weight of an alginate. Medical honey dressings are FDA cleared as safe and effective for use on wounds and burns for their stated indications, including helping to reduce the overall pH of the wound and assisting in debridement through its high osmotic potential, helping to maintain an environment for optimal wound healing.
How to Help Make Reimbursement Change for Surgical Dressings Containing Honey
According to Derma Sciences, the company is concerned about patient access and disruption of the quality economic and clinical outcomes that MediHoney® dressings can help provide for this group of patients. If you are interested in helping correct this recent change in reimbursement, please contact Ann Marie Dawidczyk – Derma Sciences Director of Reimbursement and Healthcare Policy at: firstname.lastname@example.org
Until this reimbursement issue is corrected, Supreme Medical is working in partnership with Derma Sciences to provide DME suppliers with rebate programs to ensure MediHoney® dressings remain available for home care patients that rely on Medicare Part B reimbursement for these products. If you are a DME supplier and would like more information on what options are available to you, please click here to receive further information.
About the Author
Colton Mason is the Senior Vice President of Sales & Marketing for Supreme Medical Fulfillment Systems - a national wholesale distributor of medical supplies and equipment that specializes in wound care.
His syndicated column, Healthcare Caffeine, is read by thousands of health care professionals every week – and he is pleased to deliver this special WoundSource Edition, featuring exclusive content specific to the wound care industry.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.