Acknowledgement:

Information on reimbursement in the United States is provided as a courtesy. Due to the rapidly changing nature of the law and Medicare payment policy, and our reliance on information provided by outside sources, the information provided herein does not constitute a guarantee or warranty by Smith and Nephew,Inc that reimbursement will be received.

This information is provided "AS IS" and without any other warranty or guarantee, expressed or implied, as to completeness or accuracy or otherwise. This information has been compiled based on data gathered from many primary and secondary sources, including the American Medical Association and certain Medicare contractors.

Physicians and other providers must confirm or clarify coding and coverage from their respective payers, as each payer may have differing formal or informal coding, coverage policies, or decisions. Physicians and providers are responsible for accurate documentation of patient conditions, and for reporting of procedures and products in accordance with particular payer requirements.

Reimbursement


HCPCS Codes for Application of Products

Effective January 1, 2014, the Centers for Medicare & Medicaid Services (CMS) created new codes (C5271-C5278) that HOPDs and ASCs must report to Medicare when “low cost” CTPs [old term “skin substitute graft”] are applied in their facility. Please note that Medicare has designated both OASIS® Wound Matrix and OASIS® Ultra Tri-Layer Matrix as “low cost” products.

These codes may or may not be used by non-Medicare payers. Therefore, when HOPDs and ASCs are verifying insurance benefits before applying CTPs, they should also verify if the new codes (C5271-C5278) are in their system and payable OR if the codes 15271-15278 should continue to be reported.

NOTE: Emphasis added in bold

NOTE: The wound surface area applies to the size of the recipient site, not to the size of amount of product used.

NOTE: The wrists are considered part of the arm and the ankles are considered part of the leg.

Download 2017 Coding Information specific to QHPs who apply the products and to HOPDs and ASCs when non-Medicare payers decided not to use the new HCPCS codes C5271-C5278.

Download 2017 Coding Information specific to HOPDs and ASCs when they report the application of “low cost” CTPs to Medicare or any other payer that also requires the new HCPCS codes C5271-C5278.

OASIS® is a registered trademark of Cook Biotech, Inc.
CPT® is a registered trademark of the American Medical Association.




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OASIS is a registered trademark of Cook Biotech, Inc.
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