Patients and their families weigh in about maggot therapy and reimbursement

What do patients and their families have to say about maggot therapy and reimbursement? Read for yourself -

During 2006 my mother developed a serious pressure wound at a skilled nursing home. The best conventional care . . . was woefully deficient in debridement of the necrotic tissue to promote healing. My mother’s primary care physician gave a prescription order for the MDT therapy. I then paid Monarch Labs and . . . practitioner nurse to administer about six dressings, for a total of about $1,200. The MDT treatments were vastly more effective than the Panafill ointment used by the home care nurse program. The head home care nurse observed the MDT treatment program and became so convinced of its efficacy that she tried to implement it into her own program with much resistance from management. When I applied for reimbursement our HPO was SCAN backed by Medicare. I provided all the data requested by SCAN and nothing came of it. Lots of red tape with no reimbursement due to no code for MDT. MDT was the only effective debridement method.

Mr. D. (son), California

Letter from Massachusetts, requesting HCPCS code for medicinal maggots

Another letter to CMS, requesting reimbursement coding for maggot therapy and medicinal maggots -

Medicaid HCPCS Coordinator
Centers for Medicare & Medicaid Services
Mail Stop S2-01-16
7500 Security Boulevard
Baltimore, MD 21244-1850

Dear Medicaid HCPCS Coordinator:

I am a Registered Nurse who has worked in wound care facilities for 10 years. I have tried to obtain maggot therapy for many of my patients who failed IV antibiotics and conventional debridements, but because there is no assigned HCPCS code for this product and therefore no reimbursement available, this therapy has been unobtainable for clients who would benefit from treatment.

This lack of availability has led to higher cost for inpatient surgical debridements and greater length of stay in hospitals.

I feel that maggot therapy would be a lower cost choice and should be available for use and reimbursement to these clients who need this particular therapy.

Thank you for your consideration in this matter.

Nurse F, Massachusetts

In an addendum, she added:

I have tried to obtain maggot therapy for many of my patients who failed IV antibiotics and conventional debridements, but because there is no assigned HCPCS code for this product . . . this therapy has been unobtainable . . . . because we could not be reimbursed for them, it was stopped . . . . This . . . has led to higher cost for inpatient surgical debridements and greater length of stay in hospitals.

Letter to CMS from Michigan

We received many letters to present to CMS, explaining why reimbursement coding for maggot therapy is so important. I will post a few over the next several days. They speak for themselves, for the authors, and for the biotherapy community at large.

Dear Sirs:

While I can not be physically present at your meeting, I would like to comment via this email on Medicare coverage of medical maggot therapy. I treat diabetic ulcers on a daily basis in my podiatric medical practice. It is heartbreaking to see the loss of limbs and lifestyle changes my patients must undergo. Personally I have treated some of the worst of these patients with medical maggots and gotten very gratifying results. Unfortunately, this therapy is not covered by their insurance and the patient must bear this financial burden. The people that find themselves in this position are usually the least able to afford it. This means they are denied a treatment that could potentially save their limb. I have seen both sides of this: the saved limb by maggots and the lost limb because the patient could not afford the maggots. It is imperative that Medicare develop a code for medical maggot therapy.

Sincerely,
Dr. D, Michigan