DermaWound® Insurance Reimbursement Policy and Procedure
Oct. 2021 – Dec. 2023
(Please call our Insurance Reimbursement Specialist for assistance.)

1. Coordination of Services Prior Authorization PA POLICY & PROCEDURE 10-15-2021

2. Letter of Medical Necessity and Pharmacy Pre-Authorization Form PROVIDER (1) (1)

3. Prior Authorization Request Algorithm 10-15-2021

Pressure / Bed Sores

Diabetic Leg and Foot Ulcers

Decubitus Ulcers

Surgical Wound Dehiscence

Surgical Wound Sites (ex. Post Mohs Surgery)

Indwelling Catheters & Ostomy Sites

External Fixations

Arteriosclerotic Ulcers

Ischaemic Ulcers

Non-Healing Lacerations

Traumatic Ulcers

Spider Bite Ulcers (Brown Recluse)

Amputee Stumps

Chronic or Re-occuring Wounds

Venous Stasis Type Ulcers

Ankle Ulcers

Scleroderma Ulcers

Sickle Cell Ulcers

Auto-Immune Ulcers

Non-acute Thermal Burns (Burn Ulcers)

Radiation Burn Ulcers

Minor scrapes, abrasions and blisters