COVERAGE OF THESNAP™ THERAPY SYSTEM BY PAYOR HEALTH PLAN

Payor Plan Type

Coverage based on Medical Necessity (Medical Policy is

Silent or no LCD exists)†

Coverage with Medical Policy

or LCDAARP® Medicare Plans Medicare Supplement l

Acordia Commercial l

Advantra Medicare Advantage l

Aetna® Medicare Advantage l

Affinity Health Plan Commercial l

Affinity Medical Group Commercial l

AIG Workmen’s Comp Work Comp l

AIM Mutual Insurance Work Comp l

Allegiance® Commercial l

Alliant Health Plans Commercial l

Allied Benefit Systems Commercial l

AllWays Health Partners Managed Medicaid l

Alta Bates Medical Group (Brown and Toland Physicians) Commercial l

Altius Health Plan Medicare Advantage l

Altius Health Plan Commercial l

Ambetter New Hampshire Healthy Families Managed Medicaid l

American Republic Medicare Supplement l

Amerigroup® Real Solutions Medicaid l

AmeriHealth® Insurance Company Commercial l

Amerisure® Mutual Insurance Work Comp l

Anthem® Blue Cross® Blue Shield® of Ohio Medicare Advantage l

Anthem® Blue Cross® CA Medicare Advantage l

Anthem® BlueCross® BlueShield® of Missouri Medicare Advantage l

Anthem East New Hampshire Medicare Advantage l

Apex Health Solutions Commercial l

Arbella Insurance® Commercial l

Ascension™ Health Commercial l

Assurant Health Commercial l

Asuris Northwest Health Commercial l

Atlantic Charter Work Comp l

Bankers Life and Casualty® Medicare Supplement l

Barnabas Health Plan Commercial l

Blue Care Network Commercial l

Blue Care Network of Michigan Managed Medicare l

Blue Cross® of Idaho Medicare Advantage l

Blue Cross® Blue Shield® of Alabama Commercial l

Blue Cross® Blue Shield® of Arkansas Commercial l

Blue Cross® Blue Shield® of Florida Commercial l

Blue Cross® Blue Shield® of Georgia Commercial l

Blue Cross® Blue Shield of Idaho Commercial l

Blue Cross® Blue Shield® of Illinois Commercial l

KCI REIMBURSEMENT EDUCATION HOTLINE SUPPORTS THE BUSINESS OF WOUND HEALINGOnly KCI has a team of reimbursement professionals to help you through every step of the process. Whether it’s coverage assistance for non-published coverage criteria, processing support, or education on insurance coding and guidelines, KCI is committed to supporting its customers’ needs.

For more information about SNAP™ System coverage for a particular health plan, please contact the KCI Reimbursement Education Hotline* at: 1-800-668-6812 for assistance.

*KCI Reimbursement Hotline applies to our portfolio of wound care therapies. Utilizing the hotline will allow KCI to perform a benefits and eligibility insurance coverage verification (B & E) which is completed before each application of SNAP™ System. Payor coverage will be researched to determine if there is coverage for the SNAP™ System when coverage is non-published on unclear.

Payor Plan Type

Coverage based on Medical Necessity (Medical Policy is

Silent or no LCD exists)†

Coverage with Medical Policy

or LCDBlue Cross® Blue Shield® Iowa Commercial l

Blue Cross® Blue Shield® Kansas Commercial l

Blue Cross® Blue Shield® of Massachusetts Medicare Advantage l

Blue Cross® Blue Shield® of Michigan Medicare Advantage l

Blue Cross® Blue Shield® of Minnesota Commercial l

Blue Cross® Blue Shield® of Montana Commercial l

Blue Cross® Blue Shield® of Nebraska Commercial l

Blue Cross® Blue Shield® of New Hampshire Commercial l

Blue Cross® Blue Shield® of New Mexico Commercial l

Blue Cross® Blue Shield® of North Dakota Commercial l

Blue Cross® Blue Shield® of Oklahoma Commercial l

Blue Cross® Blue Shield® of Oklahoma Medicare Advantage l

Blue Cross® Blue Shield® of Rhode Island Medicare Advantage l

Blue Cross® Blue Shield® of Tennessee Medicare Advantage l

Blue Cross® Blue Shield® of Texas Commercial l

Blue Cross® BlueShield® of Wyoming Commercial l

Blue Shield® of California Commercial l

Boon - Chapman Commercial l

Boston Medical Center HealthNet Plan Managed Medicaid l

Boston Medical Center HealthNet Plan Commercial l

Bravo Health Medicare Advantage l

Buckeye Ohio Medicaid l

Cahaba Government Benefit Administrators®, LLC A/B MAC For: AL,GA,TN Medicare l

Care Improvement Plus Commercial l

Care Improvement Plus Medicare Advantage l

Care Oregon Medicare Advantage l

Care Oregon Managed Medicaid l

Care1st Health Plan Commercial l

CareFirst® BlueCross® BlueShield® Commercial l

Caresource™ Ohio Medicare Advantage l

CareSource™ Managed Medicaid l

Commercial l

Celticare Health Plan of Massachusetts, Inc.™ Managed Medicaid l

Center for Elders Independence Commercial l

CenterLight® Healthcare Medicare Advantage l

CGS Administrators, LLC A/B MAC For: KY, OH Medicare l

Cigna® Medicare Advantage l

Commercial l

Managed Medicaid l

CMI Workers’ Compensation Work Comp l

CNIC Health Solutions™ Commercial l

Columbia United Providers Commercial l

Commonwealth Care Alliance Medicare Advantage l

Managed Medicaid l

Community Health Network of Washington Managed Medicaid l

Conifer Health Solutions® Commercial l

Connecticare Commercial l

Continental Life Medicare Supplement l

Coordinated Care™ Managed Medicaid l

County Care Health Plan Managed Medicaid l

Coventry Health Care Commercial l

Dean® Health Insurance Commercial l

Deseret Mutual Commercial l

ElderPlan Medicare Advantage l

EMI Health™ Commercial l

Employee Benefit Management Services Commercial l

Evercare Medicare Advantage l

Payor Plan Type

Coverage based on Medical Necessity (Medical Policy is

Silent or no LCD exists)†

Coverage with Medical Policy

or LCDFallon Community Health Plan Commercial l

Fallon Health Plan of MA Medicare Advantage l

Family Health Network Managed Medicaid l

Fidelis Care® Commercial l

First Carolina Care Medicare Advantage l

FirstCoast Service Options, Inc. A/B MAC For: FL, PR, VI** Medicare l

FirstPlus Medicare Advantage l

Frontpath Health Coalition® Commercial l

Gallagher Bassett Services, Inc. Commercial l

Geisinger Health Plan® Medicare Advantage l

Commercial l

Government Employees Health Association® Commercial l

Group and Pension Administrators Commercial l

Group Health® Medicare Advantage l

Hartford Worker’s Compensation Commercial l

Harvard Pilgrim Stride (HMO) Medicare Advantage Medicare Advantage l

Harvard Pilgrim Health Care Commercial l

Health Alliance Plan Medicare Medicare Advantage l

Health Net® Medicare Advantage l

Commercial l

Health Partners® Commercial l

Health Plan of Michigan Managed Medicaid l

Health Plan of Nevada MedAdvantage Medicare Advantage l

Health Plan Select, Inc. Commercial l

HealthTeam Advantage Medicare Advantage l

HealthScope Commercial l

Healthcare Management Administrators Commercial l

HealthChoice Managed Medicaid l

HealthPlus Commercial l

HealthSmart® Commercial l

Highline Medical Services Organization Commercial l

Highmark® Blue Shield® Commercial l

Highmark® BlueCross® BlueShield® West Virginia Commercial l

Horizon® BlueCross® BlueShield® of New Jersey Medicare Advantage l

Commercial l

Managed Medicaid l

Humana® Medicare Advantage l

Independence Blue Cross® Blue Shield® of Pennsylvania Commercial l

Independence Blue Cross® Medicare Advantage l

Commercial l

Independent Care Health Plan Commercial l

Independent Health Association® Medicare Advantage l

Independent Health® Association Commercial l

International Brotherhood of Electrical Workers Commercial l

Iowa Department of Human Services Managed Medicaid l

Keystone Health Plan East (Independence Blue Cross of Pennsylvania) Medicare Advantage l

Liberty Mutual® Insurance Commercial l

LifeWise Health Plan of Washington Commercial l

Mail Handlers Benefit Plan Commercial l

MaineCare (Medicaid Maine) Medicaid l

Martin’s Point Health Care® Medicare Advantage l

Commercial l

Medical Mutual® Medicare Advantage l

Commercial l

MedStar Health Medicare Advantage l

Meridian Health Plan Managed Medicaid l

Minuteman Health Commercial l

Minnesota Health Network Medicaid l

MODA Health Commercial l

Payor Plan Type

Coverage based on Medical Necessity (Medical Policy is

Silent or no LCD exists)†

Coverage with Medical Policy

or LCDMolina® Healthcare Managed Medicaid l

Mountain Health Coop Link (uses University of Utah Health Plans as TPA) Commercial l

Mutual of Omaha Medicare Supplement l

National Association of Letter Carriers Medicare Supplement l

National Government Services, Inc. (NGS) A/B MAC For:CT, IL, MA, ME, MN, NH, NY, RI, VT, WI

Medicare l

Neighborhood Health Plan™ Managed Medicaid l

Commercial l

Noridian Healthcare Solutions, LLC A/B MAC For:AK, AZ, CA, HI, ID,MT, ND, OR, SD, UT, WA, WY

Medicare l

Novitas Solutions, Inc. A/B MAC For:AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, TX**

Medicare l

Optima Health® Managed Medicaid l

Optum™ Medicare Advantage l

OptumCare™ Medicare Advantage l

Pacifi cSource Health Plans Medicare Advantage l

Commercial l

Palmetto GBA A/B MAC For: SC, NC, VA, WV Medicare l

Paramount Commercial l

Paramount Medicare Advantage l

Parkland Community Health Plan, Inc. Managed Medicaid l

Physicians Mutual® Insurance Medicare Supplement l

Physicians United Plan Medicare Advantage l

Premera Blue Cross® Commercial l

PrimeTime Health Plan Medicare Advantage l

Priority Health Medicare Advantage l

Commercial l

Priority Partners Managed Medicaid l

Professional Benefi t Administrators Commercial l

Providence Health Plan Commercial l

Regence Blue Cross® Blue Shield® of Oregon and Utah Commercial l

Regence BlueCross BlueShield of Utah Commerical, Managed Medicare, Managed Medicaid

l

Reserve National Insurance Medicare Supplement l

Royal Neighbors of America Medicare Suppleme l

SAIF Corporation Work Comp l

Scott & White Health Plan Commercial l

Medicare Advantage l

Secure Blue Medicare Advantage l

Select Health® Commercial l

Sierra Health and Life Medicare Supplement l

State Compensation Insurance Fund Work Comp l

State of Alaska Medicaid l

State of Arizona Medicaid l

State of Arkansas Medicaid l

State of Colorado Medicaid l

State of Delaware Medicaid l

State of Hawaii Medicaid l

State of Idaho Medicaid l

State of Indiana Medicaid l

State of Iowa Medicaid l

State of Kansas Medicaid l

State of Kentucky Medicaid l

State of Maine Medicaid l

State of Maryland Medicaid l

State of Massachusetts Medicaid l

State of Michigan Medicaid l

State of Minnesota Medicaid l

State of Mississippi Medicaid l

Payor Plan Type

Coverage based on Medical Necessity (Medical Policy is

Silent or no LCD exists)†

Coverage with Medical Policy

or LCDState of Nevada Medicaid l

State of New Hampshire Medicaid l

State of New Jersey Medicaid l

State of New Mexico Medicaid l

State of Ohio Medicaid l

State of Oregon Medicaid l

State of Rhode Island Medicaid l

State of South Carolina Medicaid l

State of South Dakota Medicaid l

State of Utah Medicaid l

State of Virginia Medicaid l

State of Washington Medicaid l

State of Wyoming Medicaid l

SummaCare™ Commercial l

Superior Healthplan™ Managed Medicare, Managed Medicaid,

l

SutterSelect Commercial l

Tall Tree Administrators Commercial l

Texas Municipal League Commercial l

Three Rivers Health Commercial l

Total Health Care Managed Medicaid l

Travelers Work Comp l

Tricare® Commercial l

True Blue Medicare Advantage l

Tufts Health Plan Medicare Advantage l

Commercial l

Ucare Minnesota Commercial l

United HealthCare® Medicare Advantage l

Commercial l

United Medical Resources™ Commercial l

University of Pittsburgh Medical Center Commercial l

University of Utah® Health Plans Commercial l

Managed Medicaid l

US Family Health Plan Commercial l

US Health and Life Insurance Company Commercial l

Washington State Department of Labor & Industries Work Comp l

WebTPA Commercial l

Well Sense Health Plan™ Managed Medicaid l

Wellmark® BlueCross® BlueShield® Commercial l

Wisconsin Physician Service Insurance Corporation (WPS) A/B MAC For:IA, IN, KS, MI, MO, NE

Medicare l

Disclaimer: The information provided by KCI is general reimbursement information only. It is not legal advice, nor is it advice about how to code, complete or submit any particular claim for payment. Although we supply this information for your convenience, it is the provider’s responsibility to determine and submit appropriate codes, charges, modifi ers, and bills for services rendered. Payors or their regional offi ces may have their own coding and reimbursement requirements and policies. Before fi ling any claims, providers should verify current requirements and policies with the payor.

†Payors coverage listed is based on Medical Necessity and were compiled from a list of payors who provided an authorization for application ofSNAP™ Therapy System between 2013 and 2019. Inclusion on this list is specifi c to an authorization provided; it does not indicate a claim was billedand/or payment received. It is recommended that benefi ts and eligibility insurance coverage verifi cation is performed before each application ofSNAP™ Therapy System.

Copyright 2017, 2019 KCI Licensing, Inc. All rights reserved. Third party trademarks are the property of their respective owners.Unless otherwise noted, all trademarks designated herein are proprietary to KCI Licensing, Inc., Systagenix Wound Management, Ltd., or Crawford Healthcare, Ltd. PRA-PM-US-00135 (10/19)

For more information, call the KCI Reimbursement Education Hotline at: 1-800-668-6812 (7am-7pm CST) or email: ReimbursementEducation@kci1.com