Private Payer and Medicaid

Private payers and Medicaid vary in their coverage guidelines and payment rates. Therefore, physicians and other qualified healthcare professionals (QHPs) should verify the patient's insurance benefits before applying the PICO Single Use Negative Pressure Wound Therapy System. If the procedure is covered on the patient's benefits, verify if prior authorization is required.

Please see the Insurance Benefit Verification Checklist in the Reimbursement Resources Section.

If you need assistance with Insurance Benefit Verification, please obtain the Insurance Benefit Verification Request Form in the Reimbursement Resources Section.

PICO Single Use Negative Pressure Wound Therapy System is now covered by most Medicare Advantage plans and numerous private payer plans.

NOTE:

  • Some private payers and/or Medicaid may require prior authorization and/or predetermination before approving the application of PICO Single Use Negative Pressure Wound Therapy System
  • Prior to application, physicians or QHPs should verify private payer and Medicaid codes, coverage, and documentation requirements for each patient
  • If you need assistance with insurance benefits verification and/or prior authorization requirements for the application of PICO Single Use Negative Pressure Wound Therapy System, please contact the PICO Reimbursement Helpline at 1-888-705-0061
  • If private payers deny coverage for PICO Single Use Negative Pressure Wound Therapy System because they deem it to be "experimental" or "investigational," physicians or QHPs should supply the payer's medical director with published clinical information to support the medical necessity of the PICO Single Use Negative Pressure Wound Therapy System.