West Virginia | GRAFIX PL Lyopreserved Placental Membrane and GRAFIX Cryopreserved Placental Membrane

Sierra Health and Life (UHC)

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Follows Active Medicare LCD/LCA

Anthem

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DFU (Grafix Prime only)

UHC Community Plan

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Follows Medicaid Fee-for-Service

Aetna

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DFU

Cigna

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Commercial DFU
Medicare Advantage DFU, VLU, DLEU

BCBS Federal Employee Plan

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DLEU

Department of Veterans Affairs Health Plan

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DLEU

United Healthcare

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Commercial DFU
Medicare Advantage Follows Active LCD
Retired LCD Follows Commercial

Humana

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Commercial DFU
Medicare Advantage Plans DLEU and VLU

Palmetto

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Based on Medical Necessity

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