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016.06.36-228.000. Bilaminate Graft or Skin Substitutes.

AR ADC 016.06.36-228.000Arkansas Administrative Code

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 36. Physician/Independent Lab/Crna/Radiation Therapy Center Provider Manual (Refs & Annos)
Section 224.000. Inpatient Hospital Services.
Ark. Admin. Code 016.06.36-228.000
016.06.36-228.000. Bilaminate Graft or Skin Substitutes.
Currentness
Dermal and epidermal tissue of human origin manufactured product is covered for bilaminate graft or skin substitutes when used as treatment for certain diagnoses with coverage restrictions. Refer to Section 253.000 of this manual for coverage information. Benefit limits for use of this product are:
A. Use of the skin substitute is limited to three (3) separate applications to any given ulcer.
B. There should be no fewer than six weeks between applications.
C. Treatment of any ulcer will typically last approximately twelve (12) weeks.
D. Generally, no more than two applications of the skin substitute are indicated. If, after twelve (12) weeks of compression treatment and two applications of the skin substitute, a 50% or greater improvement is noted and documented, then a third application of skin substitute will be considered for coverage. Otherwise, reapplication of the skin substitute is not recommended and other treatment modalities should be considered.
E. A repeat course of treatment with skin substitute begun within 12 months (start of treatment to start of treatment) of a previous course of treatment is not covered.

Credits

Eff. Oct. 13, 2003.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.36-228.000, AR ADC 016.06.36-228.000
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