2018 National Medicare Reimbursement Rate Summary* for Integra Dermal Regeneration Template, & Office Settings Integra LifeSciences Corporation compiles this summary of Medicare payment rates to provide information on payments for items and services related to its products. Because Medicare rates are the only publicly posted rates and many other payers use the Medicare payment levels to set their own rates, the figures below are provided as a frame of reference for customers. The identification of payment rates is not a guarantee of coverage by Medicare or other payers. Each Provider is responsible for verifying coverage with the patient s insurance carrier. Moreover, the identification of codes in this document should not be construed as providing clinical advice, dictating reimbursement policy, or substituting the judgment of a practitioner. It is always the Provider s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Preparation s for Skin Replacement Surgery** / Setting The codes listed below are typically used for burns, traumatic wounds or necrotizing infection (not intended for chronic wounds that were previously debrided). APC 15002 preparation or creation of recipient site by excision of open wounds, burn 5054 T $1568.32 A2 $771.98 eschar or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children +15003 each additional 100 sq cm, or part thereof, or each additional 1% of body area of 15004 preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of 5053 T $588.17 A2 $244.98 +15005 each additional 100 sq cm, or part thereof, or each additional 1% of body area of ** s 15002-15005 are typically used for the initial excision of a wound bed in preparation for a graft. Use debridement codes 11042 11047, or 97597-97602 for removal of nonviable tissue/debris in a chronic wound when the wound is left to heal by secondary intention when appropriate. Please check NCCI (National Correct Coding Initiative) edits to verify the appropriate reporting of debridement codes in conjunction with application of skin substitute codes 15271 15278. + = Add-on code
Topical Placement of Skin Substitute / Setting 15271 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area +15272 each additional 25 sq cm wound surface area, or part thereof (List separately in 15273 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of +15274 each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of, or part thereof (List separately in 15275 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area +15276 each additional 25 sq cm wound surface area, or part thereof (List separately in 15277 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of +15278 each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of, or part thereof (List separately in APC 5055 T $2710.30 G2 $1412.16 - T = Significant Procedure, Multiple Reduction Applies N = Items and Services Packaged into APC Rates A2 = procedure on list in CY 2007; payment based on relative payment weight. N1 = Packaged service/item; no separate payment made G2 = Non office-based surgical procedure added in CY 2008 or later; payment based on relative payment weight.
Epidermal Autograft Procedure*** - / Setting 15110 Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of +15111 each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof 15115 Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of +15116 each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof APC 5054 T $1568.32 A2 $817.15 5054 T $1568.32 A2 $817.15 ***Modifier 58 should be used if an epidermal autograft or another skin substitute is applied as part of a staged procedure applied during a different surgical encounter after the initial placement of the skin substitute. 2018 HCPCS Summary for Integra Dermal Regeneration Template and - / Setting Product Integra Dermal Regeneration Template HCPCS CY 2018 Q4105 Integra Dermal Regeneration Template (DRT), per sq cm N N1 - High Skin Sub Cost Category N/N1 = Packaged with procedure
Preparation s for Skin Replacement Surgery** Services or Non- Setting The codes listed below are typically used for burns, traumatic wounds or necrotizing infection (not intended for chronic wounds that were previously debrided). RVU 15002 preparation or creation of recipient site by excision of open wounds, burn eschar or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of +15003 each additional 100 sq cm, or part thereof, or each additional 1% of body area of 15004 preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of +15005 each additional 100 sq cm, or part thereof, or each additional 1% of body area of 3.65 $235.08 $357.48 0.80 $47.88 $77.76 4.58 $278.28 $409.68 1.60 $94.68 $128.16 ** s 15002-15005 are typically used for the initial excision of a wound bed in preparation for a graft. Use debridement codes 11042 11047, or 97597-97602 for removal of nonviable tissue/debris in a chronic wound when the wound is left to heal by secondary intention when appropriate. Please check NCCI (National Correct Coding Initiative) edits to verify the appropriate reporting of debridement codes in conjunction with application of skin substitute codes 15271 15278. Topical Placement of Skin Substitute Services or Non- Setting 15271 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area +15272 each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure) 15273 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of +15274 each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of, or part thereof 15275 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area +15276 each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure) 15277 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of +15278 each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of, or part thereof RVU 1.50 $87.48 $145.08 0.33 $18.36 $28.08 3.50 $211.68 $309.24 0.80 $47.88 $73.08 1.83 $99.00 $153.36 0.50 $26.28 $35.64 4.00 $238.68 $338.40 1.00 $60.12 $87.48
Epidermal Autograft Procedure*** Services or Non- Setting RVU 15110 Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of 10.97 $713.51 $816.83 +15111 each additional 100 sq cm, or each additional 1% of body area of, or part thereof 1.85 $109.80 $121.68 15115 Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple 11.28 $706.67 $808.19 digits; first 100 sq cm or less, or 1% of body area of +15116 each additional 100 sq cm, or each additional 1% of body area of, or part thereof 2.50 $158.76 $174.60 ***Modifier 58 should be used if an epidermal autograft or another skin substitute is applied as part of a staged procedure applied during a different surgical encounter after the initial placement of the skin substitute. 2018 HCPCS Summary for Integra Dermal Regeneration Template - Services or Non- Setting Product HCPCS Office Rate Integra Dermal Regeneration Template Q4105 Integra Dermal Regeneration Template (DRT), per sq cm At MAC**/ Payer Discretion **MAC Medicare Administrative Contractor For assistance with coding and reimbursement, please contact our Integra Reimbursement Hotline at 1-877-444-1122, option 3, option 2, Monday to Friday, 8 am to 6 pm, or via email at reimbursement@integralife.com *Disclaimer: The information provided is an abbreviated summary of coding and reimbursement rates associated with Integra Dermal Regeneration Template. Rates may represent national average payments that are subject to adjustment (e.g., for locality). The information provided is only specific to coding and reimbursement from a hospital outpatient, ambulatory surgical center, and physician office setting. Integra LifeSciences Corporation has used reasonable efforts to provide accurate coding information. While Integra LifeSciences Corporation intends to use reasonable efforts to provide accurate coding information, this information should not be construed as providing clinical advice, dictating reimbursement policy, or substituting for the judgment of a practitioner. It is always the Provider s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Integra LifeSciences Corporation assumes no responsibilities or liabilities for the timeliness, accuracy, and completeness of the information contained herein. Since reimbursement laws, regulations, and payor policies change frequently, it is recommended that providers consult with their payors, coding specialists, and/or legal counsel regarding coverage, coding and payment issues, and/or legal counsel regarding coverage, coding, and payment issues. Reference: Book 2018. Current Procedural Terminology () copyright 2017 American Medical Association (AMA). All rights reserved. is a registered trademark of the AMA. Fee Schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Integra and the Integra logo are registered trademarks of Integra LifeSciences Corporation in the United States and/or other countries 2018 Integra LifeSciences Corporation. All rights reserved T - 0530281 1 0865096 1 (2017-12)