Skin Substitutes

CMS provides pricing for some wound care products; however, there are many that do not have established pricing. When a skin substitute/wound care product does not have established pricing, the pricing for the item will be dependent on the cost of the item.

When billing Medicare Part B you must provide:

An invoice price or acquisition cost for that item
Total size of the product being used

This information should be included in item 19 of the CMS-1500 claim form or the electronic equivalate (Loop 2400, NTE Section).

The amount must match the size type indicated by the HCPCS code. If the code is defined as per square centimeter, the units billed must match the size billed in square centimeters. For example, Q4100-Q4226 are coded as per square centimeter. If you have a product that is 4x4 square centimeters, 16 units would be entered.

Skin Substitutes

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