Marshall Mg Foot Controller Manual

Marshall Mg Foot Controller Manual 4,5/5 7275votes

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Aetna considers the following products for wound care medically necessary according to the criteria indicated below Apligraf graftskinAetna considers a culture derived human skin equivalent HSE called Apligraf graftskin medically necessary for any of the following indications For use with standard diabetic foot ulcer care for the treatment of full thickness neuropathic diabetic foot ulcers of greater than 3 weeks duration that have not adequately responded to conventional ulcer therapy and which extend through the dermis but without tendon, muscle, capsule or bone exposure or. In conjunction with standard therapy to promote effective wound healing of chronic, non infected, partial and full thickness venous stasis ulcers that have failed conservative measures of greater than 1 month duration using regular dressing changes and standard therapeutic compression. Aetna considers Apligraft experimental and investigational for all other indications e. Dermagraft. Aetna considers Dermagraft human fibroblast derived dermal substitute medically necessary for use i in the treatment of full thickness diabetic foot ulcers greater than 6 week duration that extend through the dermis, but without tendon, muscle, joint capsule or bone exposure, and ii in the treatment of wounds related to dystrophic epidermolysis bullosa. Note Consistent with the Food and Drug Administration FDA approved labeling of Dermagraft, the product should be used in conjunction with standard wound care regimens. In addition, the product is not considered medically necessary in persons with an inadequate blood supply to the involved foot. Aetna considers Dermagraft experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established. Dermagraft is contraindicated and has no proven value in infected ulcers and ulcers with sinus tracts. Systemic Hyperbaric Oxygen Therapy HBOTAetna considers systemic hyperbaric oxygen therapy HBOT medically necessary as an adjunctive method for treating non healing, infected, deep lower extremity wounds in members with diabetes when criteria in CPB 0. Hyperbaric Oxygen Therapy HBOT are met. Trans. Cyte. Aetna considers Trans. Cyte allogeneic human dermal fibroblasts, a biosynthetic dressing, medically necessary for the temporary wound covering for surgically excised full thickness and deep partial thickness thermal burn wounds in persons who require such a covering before autograft placement and for the treatment of mid dermal to indeterminate depth burn wounds that typically require debridement and that may be expected to heal without autografting. Aetna considers Trans. Cyte experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established. Orcel. Aetna considers Orcel bilayered cellular matrix medically necessary for healing donor site wounds in burn victims, and for use in persons with dystrophic epidermolysis bullosa undergoing hand reconstruction surgery to close and heal wounds created by the surgery, including those at donor sites. Aetna considers Orcel experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established. Biobrane Biosynthetic Dressing. Aetna considers Biobrane biosynthetic dressing medically necessary for temporary covering of a superficial partial thickness burn wound. Visio Mechanical Shapes. Aetna considers Biobrane biosynthetic dressing experimental and investigational for all other indications because its effectiveness for indications other than the one listed above has not been established. Integra Dermal Regeneration Template and Integra Bilayer Wound Matrix. Aetna considers Integra Dermal Regeneration Template, Integra Bilayer Matrix Wound Dressing, and Integra Meshed Bilayer Wound Matrix collagen glycosaminoglycan copolymers medically necessary for the treatment of individuals with severe burns where there is a limited amount of their own skin to use for autografts or they are too ill to have more wound sites created. Aetna considers Integra Dermal Regeneration Template and Integra Omnigraft Dermal Regeneration Template medically necessary for the treatment of partial and fullthickness neuropathic diabetic foot ulcers that are greater than 6 weeks in duration with no capsule, tendon or bone exposed, when used in conjunction with standard diabetic ulcer care. Aetna considers Integra Dermal Regeneration Template and Integra Bilayer Wound Matrix experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established. Alloderm. Aetna considers Alloderm and Alloderm RTU acellular dermal tissue matrix medically necessary for breast reconstructive surgery see CPB 0. Breast Reconstruction Surgery. Aetna considers the use of Alloderm experimental and investigational for all other indications e. Freys syndrome following parotidectomy, and for use in reconstruction of the upper extremity because its effectiveness for indications other than the one listed above has not been established. Artiss. Aetna considers Artiss fibrin sealant medically necessary for the treatment of individuals with severe burns. Aetna considers Artiss fibrin sealant experimental and investigational for all other indications because its effectiveness for indications other than the one listed above has not been established. Oasis Wound Matrix. Aetna considers Oasis Wound Matrix medically necessary for treatment of difficult to heal chronic venous or diabetic partial and full thickness ulcers of the lower extremity that have failed standard wound therapy of at least 4 weeks duration. Aetna considers Oasis Wound Matrix experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established. Graftjacket Regenerative Tissue Matrix. Aetna considers Graftjacket Regenerative Tissue Matrix medically necessary for treatment of full thickness diabetic foot ulcers greater than 3 week duration that extend through the dermis, but without tendon, muscle, joint capsule or bone exposure. Aetna considers Graftjacket Regenerative Tissue Matrix experimental and investigational for all other indications e. Epicel. Aetna considers Epicel cultured epidermal autograft medically necessary for members who have deep dermal or full thickness burns comprising a total body surface area of greater than or equal to 3. Note Epicel may be used in conjunction with split thickness autografts, or alone in persons for whom split thickness autografts may not be an option due to the severity and extent of their burns. Aetna considers Epicel cultured epidermal autograft experimental and investigational for all other indications because its effectiveness for indications other than the one listed above has not been established. Epifix. Aetna considers Epifix medically necessary for treatment of partial and fullthickness neuropathic diabetic foot ulcers that are greater than 6 weeks in duration with no capsule, tendon or bone exposed, when used in conjunction with standard diabetic ulcer care. Aetna considers Epifix experimental and investigational for all other indications. Grafix. Aetna considers Grafix Core and Grafix Prime medically necessary for treatment of partial and full thickness neuropathic diabetic foot ulcers that are greater than 6 weeks in duration with no capsule, tendon or bone exposed, when used in conjunction with standard diabetic ulcer care. Aetna considers Grafix experimental and investigational for all other indications.