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!