How to Prescribe ENLUXTRA Self-Adaptive Wound Dressings
We receive many inquiries on how to prescribe Enluxtra correctly and have the prescription filled successfully and quickly.
Our Clinical Director, Vicki Fischenich, has answers that should help you and your patients.
Question 1: What are the billing HCPCS codes for available Enluxtra dressing sizes? What are the reimbursement rates for both sizes?
- Enluxtra 4" x4" dressing, HCPCS code A6196, is reimbursed slightly above $8.00 per dressing with a maximum allowed 30 dressings per wound, per month, for a total of approximately $240.
- Enluxtra 6" x6" dressing, HCPCS code A6197, is reimbursed slightly above $18.00 per dressing with a maximum allowed of 30 dressings per wound, per month, for a total of approximately $540.
Question 2: What should be written in the prescription to avoid prescription denial by the payor or DME supplier and ensure it is filled correctly?
Answer: Be as specific as possible.
- Write the quantity of dressings you want your patient to have for the month and the frequency of dressing changes. Once a prescription is filled for the month, the patient will not be able to get any more dressings until next month.
- Include the size of dressing required for the patient's wound (4" x4" or 6" x6"). Always include compromised peri-wound area when calculating the size of Enluxtra dressing.
- Include words "No substitutions" to ensure the patient receives Enluxtra and not another product.
- Include words "full-thickness wound, moderate or heavy drainage" (even though Enluxtra is optimal for any wound, it is covered for exuding wounds only).
- Document the wound size and condition well for each wound and include all relevant wound care notes required by DME services with the prescription. For multiple wounds, list the number of wounds and the size and quantity of dressings for each wound. Learn what documentation can be included in relation to the compromised peri-wound area outside of wound edges.
- To get help with proper wound documentation, consult your DME supplier's billing expert or case manager, or your local DME representative.
Question 3: Is a quick order form available for DME orders that nursing staff can quickly check off and fax?
Answer: Speak with your local or national DME provider and ask if a custom order form with preferred products can be created. View an example form:
Question 4: My patient is covered by Medicaid (state) insurance and was told that Enluxtra products are not covered. Is it true?
Possible reasons: Even though Enluxtra is a covered product, a DME provider may be reluctant to fill the prescription if their reimbursement rate with Medicaid is lower than with Medicare which results in decreased profit margin for the DME provider.
Possible solutions: Try a different DME provider, many of them might have a higher reimbursement rate and will fill the prescription. Reach out to your local DME representative and get a list of insurance carriers they contract with. Ask DME providers that stop by and call on your site about their policies with state-funded programs.
Question 5: My patient did not get Enluxtra, but another dressing was substituted. How can I prevent this from happening?
Possible reasons: DME provider policy might allow for substitutions.
Solution: Be specific on the wound care orders. Write "NO SUBSTITUTION" on the prescription to ensure your patient receives Enluxtra dressings.
Question 6: My patient received 4" x 4" dressings, but their wound requires 6" x6" dressings. Why did this happen?
Possible reason: You might be using a DME provider that only stocks the 4" x4" Enluxtra dressing size.
Solution: Contact the DME provider and have them correct or address the issue, or reach out to the local DME representative for assistance. On the prescription, include a note from MD/healthcare provider that states that the 6" x6" dressing size is required due to wound size.
Question 7: My patient was told by a DME provider that Enluxtra dressing is back-ordered from the manufacturer and will not arrive for several weeks. Is it possible?
Possible reason: DME provider has not stocked Enluxtra inventory adequately.
Solution: Contact the DME provider and ask them when they will have Enluxtra in stock. Or choose a different DME.
Question 8: My DME provider only supplied my patient with 12 Enluxtra dressings. Why is that?
Possible reasons: DME providers follow your wound care orders and Medicare rules and supply only as many dressings as your order calls for each month.
Example: If you prescribe dressing changes 3 times a week, your patient will receive 12 dressings for a month (4 weeks x 3 changes). If the dressings are used up before the end of the month, the patient will not be able to get any more dressings until next month.
Solution: Be specific on the wound care orders to avoid misinterpretation. First, indicate the quantity as 30. Secondly, prescribe daily changes if the patient will need 30 dressings for the month.
When this is important: Daily dressing change is recommended for moderate to heavily draining wounds and wounds with heavy bioburden, a larger amount of slough or devitalized tissue in the wound bed and surrounding peri-wound area.
Question 9: I have a DME (Durable Medical Equipment) License, and I would like to carry Enluxtra Self-Adaptive Dressings. How can I do this? Or what are the steps to adding Enluxtra to my medical supplies list?
Please email firstname.lastname@example.org for distributor pricing and the best buying options.
Question 10: My patient's wound is dry or minimally draining. Can I still prescribe Enluxtra?
It can be prescribed, but Enluxtra will not be covered for dry or minimally draining wounds. For dry and low-exuding wounds, your patient may only need 4 Enluxtra dressings to heal fully, resulting in the total out-of-pocket expense of about $30.00 for the whole month. Enluxtra is an OTC product and can be purchased here.