Healix360 provides advanced mobile wound care through licensed physicians and nurse practitioners. Care is provided in homes, assisted living communities and skilled nursing facilities in listed California service areas.
Accepted Insurance Plans
| Plan Type | Who Qualifies | What's Covered | Copay / Coinsurance |
|---|---|---|---|
| Medicare Part B | Individuals aged 65 and older who have enrolled in Part B | Initial wound consultation and ongoing evaluation and management visits (CPT 99202-99215)... | After meeting the annual Part B deductible ($257 in 2025), Medicare pays 80% of the Medicare-approved amount and you are responsible for the remaining 20% coinsurance. There is no annual out-of-pocket maximum under Original Medicare alone. Most patients pair Part B with a Medigap (supplemental) policy such as Plan G or Plan N, which absorbs the 20% coinsurance and leaves the patient with little to no cost at the time of service. Healix360 serves listed communities in California. Confirm your exact address and visit availability with our team. |
| Medicare Advantage (Part C) | Anyone enrolled in both Medicare Part A and Part B who lives in the plan's service area | All Original Medicare Part A and Part B services, at minimum... | Cost-sharing varies by plan. Medicare Part B may cover medically necessary wound care for eligible patients. Coverage is verified before treatment. PPO plans have separate in-network and out-of-network cost-share tiers. All Medicare Advantage plans must have a Maximum Out-of-Pocket (MOOP) limit; in 2025 the federal in-network MOOP cap is $9,350 (combined cap for in- and out-of-network on PPOs is $14,000). Once the MOOP is reached, the plan pays 100% of covered services for the rest of the calendar year. |
| Medi-Cal | Adults with household income up to 138% of the federal poverty level | Wound evaluation and ongoing management visits... | Medicare Part B may cover medically necessary wound care for eligible patients. Coverage is verified before treatment. A small subset of Medi-Cal members in higher income tiers may have a Share of Cost (SOC) that must be met monthly before benefits activate; our team identifies and explains SOC at intake. Medicare Part B may cover medically necessary wound care for eligible patients. Coverage is verified before treatment. |
| Covered Supplies | Patients with an open wound who have a written order from a treating physician or nurse practitioner | Primary dressings, alginates, foams, hydrogels, hydrocolloids, collagen, antimicrobial silver, contact layers (HCPCS A6000-A6512)... | Under Medicare Part B, supplies covered under the Surgical Dressings benefit are paid at 80% of the Medicare-approved amount after the annual Part B deductible ($257 in 2025). The patient owes the remaining 20%, which is typically absorbed by Medigap or by Medi-Cal Medicaid for dual-eligible patients. DME items such as NPWT pumps follow the same 80/20 split. Medicare Part B may cover medically necessary wound care for eligible patients. Coverage is verified before treatment. |
| Biologic Coverage | Patients with chronic non-healing wounds, diabetic foot ulcers, venous leg ulcers, pressure injuries, post-surgical wounds, that have failed at least 30 days of standard care | FDA-cleared cellular and tissue-based products on the CMS Q-code list (Q4100 series), updated quarterly... | Under Medicare Part B, both the product and the application are paid at 80% of the Medicare-approved amount after the annual Part B deductible ($257 in 2025). The patient owes 20%, typically absorbed by Medigap or by Medi-Cal Medicaid for dual-eligibles. Because biologic products are expensive, the 20% can be substantial without supplemental coverage, a single application of a high-cost product can exceed $1,500 to $3,000 in total reimbursement, with the patient share proportional. Medicare Part B may cover medically necessary wound care for eligible patients. Coverage is verified before treatment. The Healix360 verification team calculates the patient's exposure in writing before therapy begins. |
| Eligibility Verification | Every new patient referred for wound care services receives full verification before the first visit | Confirmation of active Medicare Part A and Part B status, including the coverage effective date... | There is no patient cost for the verification itself, it is part of the standard intake workflow performed by the Healix360 coordination team at no charge. Verification produces a written cost estimate showing the projected patient share for upcoming services so there are no surprises at billing. |
| Skin Substitute Coverage (2026 Update) | Diabetic foot ulcers (Wagner Grade 1-2) that have failed 30+ days of standard offloading and moist wound care | FDA-cleared bioengineered skin substitutes (Apligraf, Dermagraft) under their Q-codes... | Under Original Medicare, the patient owes 20% coinsurance on both the application code and the product Q-code after the annual Part B deductible. Medigap policies absorb that 20%. Under Medicare Advantage, plans typically charge a flat specialist copay or coinsurance subject to the plan's annual MOOP. Medicare Part B may cover medically necessary wound care for eligible patients. Coverage is verified before treatment. |
Medicare Part B
Coverage for medically necessary outpatient services, including advanced wound care.
Medicare Advantage (Part C)
Managed care plans that provide all Part A and Part B benefits.
Medi-Cal
California's Medicaid program serving low-income individuals.
Covered Supplies
What dressings, devices, and durable medical equipment are typically covered for wound care.
Biologic Coverage
Medicare Part B may cover medically necessary wound care for eligible patients. Coverage is verified before treatment.
Eligibility Verification
How insurance coverage is verified and what information patients and families need to provide.
Skin Substitute Coverage (2026 Update)
Medicare Part B may cover medically necessary wound care for eligible patients. Coverage is verified before treatment.
How Verification Works
We handle the paperwork and coordinate authorization before your first visit.
1
Provide Details
Submit your insurance information securely through our intake process or over the phone.
2
We Check Benefits
Our coordination team contacts your insurer to verify active coverage, deductibles, and network status.
3
Prior Authorization
If your plan requires authorization for specific treatments, we work with the clinical team to submit necessary documentation.