Commercial DFU
Medicare Advantage Plans DLEU and VLU
Policy No.
HCS-0370-34
States
Grafix Core Q4132
Commercial and Medicare Advantage Covered – DFU/VLU/DLEU; Other Wounds Based on Medical Necessity
Grafix PL/Prime Q4133
Commercial and Medicare Advantage Covered – DFU/VLU/DLEU; Other Wounds Based on Medical Necessity