PolyMem WIC® Silver Cavity Filler

Last updated on 11/10/22 | First published on 1/8/18 | Literature review current through Oct. 2024 [cite]

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Technology and Product Assessment

Product Type: Antimicrobial

Unbiased information for educational purposes only. WoundReference does not produce, market, advertise, re-sell or distribute healthcare goods or services consumed by, or used on patients. For information about specific products, please contact the manufacturer directly.

PolyMem WIC® Silver Cavity Wound Filler is a foam dressing.
INTENDED USES: For use on pressure ulcers (stages 3-4), vascular ulcers, diabetic ulcers and acute wounds.
CLAIMED FEATURES: Donates moisture or absorbs exudate, depending on condition of wound bed and fluid level in dressing. Continuous cleansing reduces need to cleanse wound bed during dressing changes. Will not stick to the wound bed while maintaining integrity of healing tissue. Expands within the wound cavity and undermined areas to fill dead space. Small particle silver provides an antimicrobial reservoir in the dressing. Expands up to one-third as wound fluid is absorbed. Perforated for ease of use and can be cut to size. Absorbs and holds up to ten times its weight. Soft and pliable, conforms to wound shape. Will not dehydrate wound bed.
OPTIONS: 1" X 3" (2.5cm X 8cm), 1.3 Grams, 14 per Box - 5 Boxes per Case

Manufacturer: Ferris Mfg. Corp

Information retrieved from manufacturer and/or FDA-approved labels

* Wound Reference does not produce, market, re-sell or distribute health care goods or services consumed by, or used on, patients. The product information contained on this page, including the product images and additional product materials, was collected from various supplier sources. All product claims and specifications are those of the product suppliers. Every effort has been made to ensure the accuracy of the product information, however on occasion manufacturers may alter their products or packaging without notice. Wound Reference assumes no liability for inaccuracies or misstatements about products. The properties of a product may change or be inaccurate following the posting or printing of the product information in the document, either in the print or online version. Due to product changes, information listed in this document is subject to change without notice. We recommend that you always read labels, warnings and instructions for use before using a product. Content on this site is for reference purposes and is not intended to be a substitute for professional advice given by a physician or other licensed healthcare professional.

ESSENTIALS

Product

Estimated
Out-of-pocket
Cost

HCPCS Class

HCPCS

PolyMem WIC® Silver Cavity Wound Filler, 1" X 3" (2.5cm X 8cm), 1.3 Grams, 14 per Box - 5 Boxes per Case

Foam dressing, wound filler, sterile, per gram

A6215

PolyMem WIC® Silver Cavity Wound Filler, 3" X 3" (8cm X 8cm), 4 Grams

Foam dressing, wound filler, sterile, per gram

A6215

* Hover on the information button next to each header for detailed explanation on the type of information provided by the table

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DME coverage and co-payment

Product

Estimated
Out-of-pocket
Cost

Patient DME Co-Payment per Billable Unit

DME Reimbursement to Suppliers

Frequency Replacement if Requirements Met

Office and/or Facility - Product reimbursement

Ferris Mfg. Corp
PolyMem WIC® Silver Cavity Wound Filler, 1" X 3" (2.5cm X 8cm), 1.3 Grams, 14 per Box - 5 Boxes per Case

$.00
per gram (carrier discretion)

1 change/day

Ferris Mfg. Corp
PolyMem WIC® Silver Cavity Wound Filler, 3" X 3" (8cm X 8cm), 4 Grams

$.00
per gram (carrier discretion)

1 change/day

* Every effort has been made to ensure the accuracy of the product information, however you should visit the manufacturer's website for the latest information.

* Hover on the information button next to each header for detailed explanation on the type of information provided by the table

Product

Estimated
Out-of-pocket
Cost

Recom / Evidence

FDA Safety

Quality Measures

Cost Effectiveness

PolyMem WIC® Silver Cavity Wound Filler, 1" X 3" (2.5cm X 8cm), 1.3 Grams, 14 per Box - 5 Boxes per Case

Coming soon

PolyMem WIC® Silver Cavity Wound Filler, 3" X 3" (8cm X 8cm), 4 Grams

Coming soon

Product

Estimated
Out-of-pocket
Cost

Features

PolyMem WIC® Silver Cavity Wound Filler, 1" X 3" (2.5cm X 8cm), 1.3 Grams, 14 per Box - 5 Boxes per Case

Application: Can be used as primary dressing Depth: Full thickness (deep) Exudate: Low Exudate: Moderate Exudate: High Indications: May be applied over infected tissue Indications: May be used to pack deep wounds Indications: May be used under compression Medicare freq of replacement: 1/day Wear time: Up to 7 days

PolyMem WIC® Silver Cavity Wound Filler, 3" X 3" (8cm X 8cm), 4 Grams

No CPT codes to display.

Hover on the information button next to each header for detailed explanation on the type of information provided by the table
The information provided on this website is informational only. This is not a guarantee of Reimbursement Rates, nor is it intended to make recommendations regarding clinical practices. Information on this website is subject to change with out notice due to changes in reimbursement laws, regulations, rules and policies. The ultimate responsibility for correct coding lies with the provider of services. Please contact the appropriate payer for their interpretation of the appropriate code to use for the procedure.
CPT® is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2018, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Codes referenced on Wound Reference are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage. Providers should reference the American Medical Association prior to the submission of claims for reimbursement of covered services.

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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

Topic 711 Version 1.0

PolyMem WIC® Silver Cavity Filler

PolyMem WIC® Silver Cavity Filler

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