Coverage & Access
A Framework for Coverage
Understanding medical necessity, clinical coding, and access options for patients who need a safer recovery environment at home.
Medical Necessity & Clinical Coding
Understanding Medical Necessity
Clinical conditions and treatment-related vulnerabilities can make environmental protection an important consideration during recovery.
Encounter for Chemotherapy
Z51.11
Mandatory environmental containment of hazardous antineoplastic metabolites excreted post-treatment.
Drug-Induced Immunodeficiency
D84.821
Complete destruction of natural biological immune defenses due to oncology medications.
Severe Neutropenia
D70.18
Predictive immune failure requiring absolute mechanical host isolation from environmental vectors.
Chemotherapy-Induced Mucositis
K12.31
Disruption of oral/gut mucosal linings, creating an unshielded, direct portal of entry to the bloodstream.
WAYS TO ACCESS THE PROGRAM
Three Paths to Patient Access
We support multiple pathways to help ensure that patients can access the Keep Me & My Family Safe Program.
Option 1
Facility Provided
Many progressive oncology programs purchase the Keep Me & My Family Safe Program kits directly and provide them to high-risk patients at discharge as a necessary adjunct to their ongoing oncology treatment.
The Objective:
Immediate patient protection during active therapy.
Option 2
Patient Purchase
Where facility funding is not directly available, centers can facilitate a direct-purchase option. Patients or caregivers can secure a complete safety kit for $175.00 or through structured center co-pays.
The Objective:
Direct access to vital protection without delay.
Option 1
The Path to DME Coverage
We have presented our case to the CMS HCPCS Level II Committee to establish Durable Medical Equipment (DME) coverage. A final benefit category decision is anticipated in August, with an effective date targeted for October 1.
The Objective:
Expanding long-term, affordable insurance access for patients.
GET THE GUIDANCE YOU NEED
Questions About Coverage?
Looking for clarity on coding, medical necessity, or reimbursement options? Our team can help you understand the available pathways and next steps.