Reimbursement Pathway

Medicaid & Medicare Coverage

Existing HCPCS codes · New York State precedent · 2027 expansion pathway

Notice: RashEndZ™ is not currently approved for universal Medicare or Medicaid reimbursement. Established HCPCS codes exist for topical oxygen therapy and state-level Medicaid coverage has precedent.

Existing HCPCS Billing Codes

A4575

Topical hyperbaric oxygen chamber, disposable

DME MAC jurisdiction · Established 2003

E1390

Oxygen concentrator, single delivery port, ≥85% O₂

Active Medicare reimbursement · 36-month rental coverage

New York State Precedent

NY Medicaid — Topical Oxygen Wound Therapy (TOWT)

New York Medicaid established coverage guidelines using codes A4575 + E1390 in combination. Program operated through 2017 — demonstrating state-level reimbursement feasibility.

Coverage authorized for complete wound therapy program criteria. Prior authorization for up to 16 days per 28-day treatment cycle.

Regulatory Background

CMS NCD 20.29 — April 2017

CMS revised the Hyperbaric Oxygen Therapy National Coverage Determination to remove non-coverage language for topical oxygen therapy — granting DME MACs discretion to determine coverage. Combined with growing international guideline endorsements (ADA, IWGDF, WHS, EWMA), this creates a favorable environment for reimbursement expansion.

Coming 2027

Expanded Clinical Evidence & Reimbursement Pathway

Additional clinical research publication in 2027 expected to support expanded Medicaid reimbursement in multiple states as evidence base and guideline recognition continue to grow.