North Carolina Medicaid (FFS)

DFU

Policy No.

1G-2

Grafix Core Q4132

Primary Position- DFU

When Secondary to Medicare-DFU/VLU/DLEU; Other Wounds Based on Medical Necessity

Grafix PL/Prime Q4133

Primary Position- DFU

When Secondary to Medicare-DFU/VLU/DLEU; Other Wounds Based on Medical Necessity