Patient Eligibility | Advanced Wound Care Innovations

Am I Eligible?
Checklist for Patients

🏥 Basic Medical Requirements

✅ Patient has active Medicare Part B coverage (or equivalent primary insurance that pays for skin substitutes).

✅ Medicare deductible is met or addressed

✅ If Medicare-only:

Patient may owe 20% coinsurance unless secondary insurance (Medicaid, Medigap, etc.) is available.
Financial hardship policy available if needed.

✅ If Medicare Advantage:

Confirm plan coverage and prior authorization rules (varies by plan).

✅ LCD (Local Coverage Determination) Compliance:

Wound has been treated with standard of care for at least 4 weeks (documented)
Serial measurements of the wound must be recorded (length × width × depth)
Wound shows less than 20–30% improvement after standard care, triggering eligibility for skin substitute application
Graft usage must align with LCD limits (e.g., number of applications, wound type criteria)

✅ No contraindications:

Untreated wound infection
Untreated osteomyelitis (bone infection)
Allergy to graft materials

📋 Insurance and Coverage Requirements

✅ Patient has one or more chronic wounds that have been present for 30 days or longer despite standard care.

✅ Wound types eligible:

Diabetic foot ulcer (DFU)
Venous stasis ulcer
Pressure injury (stage 3 or 4)
Traumatic wounds
Post-surgical or non-healing surgical wounds
Radiation-induced wounds
Burns (partial-thickness)

✅ Wound is not healing with standard dressings and basic wound care alone.

✅ Wound is clean, free of active infection, and appropriate for biologic grafting.

✅ Documentation available showing ongoing wound management:

Debridement history
Dressings used
Wound measurements and notes
Progress (or lack of progress) over time

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