Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut MED.00110 Silver-based Products for Wound and Soft Tissue Applications Form

Effective Date

01/03/2024

Last Reviewed

11/09/2023

Original Document

  Reference



This document addresses the use of antimicrobial silver wound dressings, (for example, Acticoat, Actisorb™, and Silversorb®). Such products have been proposed for the treatment of wounds and soft tissue.

Note: For information regarding the use of other soft-tissue, bone and fat grafting products, please see:

  • MED.00132 Adipose-derived Regenerative Cell Therapy and Soft Tissue Augmentation Procedures
  • SURG.00011 Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting
  • TRANS.00035 Therapeutic use of Stem Cells, Blood and Bone Marrow Products

Position Statement

Investigational and Not Medically Necessary:

Antimicrobial silver wound dressings, (for example, Acticoat, Actisorb, and Silversorb) are considered investigational and not medically necessary for all applications.