SenSura Mio is now extended wear
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The #1 ostomy brand in the world, SenSura® Mio products are now extended wear*!

 

Effective August 11th, PDAC, the Medicare Contractor for Pricing, Data Analysis and Coding has changed the coding of Coloplast SenSura® Mio products from a standard wear to an extended wear coding category.

While the brand was initially launched into the standard wear category, recent user experience1, clinician evaluation2, and lab-based data3 reinforces SenSura Mio’s performance as an extended wear product. This change helps expand access to users who need or would prefer an extended wear product.

When combined with its full-circle filter, discreet neutral-gray textile, wide outlet, and unique BodyFit Technology, SenSura Mio products should be the preferred choice for you or your patients.

*Excluding 1-piece closed-end pouches, SenSura® Mio Baby, and SenSura® Mio Kids

1Ostomy pouch user survey, 2021, n=1,648. Dataset collected by Coloplast but includes all brands. Data on file.
2Product evaluation of SenSura Mio Convex, 2016, n=98 clinicians. Data on file.
3Data from bench testing performed by Coloplast; may not be indicative of clinical performance. Data on file.

What does this mean?

This means your current product has been assigned a new code in the Healthcare Common Procedure Coding System (HCPCS). These standardized code sets are necessary for Medicare and other health insurance providers to process healthcare claims fairly and accurately. HCPCS are different than the product codes, your current product code remains unchanged.

Are all Mio ostomy products now extended wear?

All SenSura Mio adult products have been reclassified as extended wear except for 1-piece closed pouches.

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Will I require a new prescription?

Yes, in order to continue using SenSura Mio, you will likely require an updated prescription – but your supplier will likely work with your clinician to request a new prescription on your behalf.

 

Will there be a change in cost?

You will receive an Explanation of Benefits (EOB) from your insurance provider reflecting this coding change. If you do not have a secondary insurance and your plan has a copay you may see a change to your copay, depending on the product and amount you use. Consult with your supplier for specifics relevant to your insurance plan and product usage.

 

Can I decide to continue using a standard wear product?

If you want to try an alternate standard wear pouching system, our Coloplast® Care team is available at 1-877-858-2656 to discuss alternatives – including the skin-friendly double-layer SenSura standard wear.

 

Do you have more questions?

Call us at 1-877-858-2656 with any product-related questions; we’ll be happy to help! – or contact your supplier if you have further questions to your specific situation regarding billing or prescription.

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When should I start using new HCPCS codes when writing prescriptions?

Effective immediately, please start using new HCPCS for SenSura Mio adult adhesive barriers (1-piece pouches or 2-piece barriers), except for 1-piece closed pouches.

 

Will existing patients using SenSura Mio require a new prescription?

Yes, patients who would like to continue using SenSura Mio will require an updated prescription. We will reach out to you to request an updated prescription, where applicable.

 

Will there be a change in cost for the patient?

There may be a change in the patient’s copay and Explanation of Benefits (EOB), but this will vary based on the type of insurance they carry.

 

Will patients' monthly allowances change?

Currently monthly allowances vary by plan. For Medicare beneficiaries, extended wear category allowances are typically not significantly different to standard wear; for patients with other insurance plans, refer them to their supplier for specific details relevant to their product usage and insurance coverage.

 

How does this change help expand access to users who need or would prefer an extended wear product?

One of the core reasons for the recategorization was to expand access to patients who need or would like an extended wear solution – either because they're looking for the erosion resistance, strong adhesive seal, and wear time the "extended wear" category connotes, or because they're already using a product within the category.

 

Below is an overview of the products recently verified to change categories, listed with their corresponding HCPCS (before and after the change):

 

Do you have more questions?

Contact your local Coloplast Ostomy representative with any questions; s/he will be happy to help!

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SenSura Mio fits regular body profiles and has twice the stretch of a conventional product. The elasticity enables the appliance to move with your body, while maintaining a secure fit. The appliance stays securely in place, giving you more confidence and peace of mind throughout the day.

Available in 1-piece and 2-piece with Click and Flex coupling.

SenSura Mio Convex is proven to reduce leakage for inward areas around the stoma. The adhesive stays securely on the skin, creating a reliable seal between the skin and the baseplate. Flexlines ensure the convex shell bends around the stoma - not in the middle of it, so you can bend and stretch without worrying. Read more about SenSura Mio Convex. 

Available in 1-piece and 2-piece, with Click or Flex coupling.

SenSura Mio Convex Flip is the first product specially designed for outward body profiles. The curved, star-shaped baseplate hugs the body for a good fit with less creasing and folding. Fit zones in the centre zone and outer rim provide extra flexibility, so the baseplate stays in place during body movement. Read more about SenSura Mio Convex Flip. 

Available in 1-piece and 2-piece, with Click coupling.

Coloplast Corp. provides this information for convenience and your general reference only. It does not constitute legal advice or a recommendation regarding clinical practice. Reimbursement, coverage and payment policies can vary from one insurer and region to another and is subject to change without notice. The provider has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided. Coloplast does not guarantee coverage or payment of products and Coloplast makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare, insurers, or other payers as to the correct form of billing or the amount that will be paid.

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