Reimbursement Information

Skin grafting candidate

Coding & Reimbursement (U.S. Only)

One of SteadMed Medical's missions is to provide medical technologies that help troublesome wounds heal, and at a cost that allows the therapy to reach patients all around the world.

The Xpansion® product was developed in part to address the lack of access to expensive, often unproven technologies many patients face when dealing with chronic wounds. Health care providers (HCP’s) have the opportunity to treat wounds in both inpatient and outpatient settings using this new instrument kit. By enabling HCP’s to perform autografting in an outpatient setting and eliminate the use of other expensive therapies, the Xpansion product has the potential to dramatically reduce the cost of care.

The following coding information is provided for informational purposes only. Each provider is responsible for accurately reflecting the procedure performed based on the work provided to the patient and reflected in the medical notes.

The coding information provided reflects the AMA CPT® 2012 Professional Edition*and coding guidance related to autologous skin grafting. The AMA CPT® 2012 Professional Edition codes are separated into groups:

a) Describing the preparation of the skin graft recipient site, including the preparation of a clean and viable wound surface. Procedure codes reflecting the intention to achieve primary closure may be selected from 15002-15005.

b) The harvesting and maintenance of the donor tissue for the autologous skin graft may be selected from CPT codes 15100, 15101, 15120, and 15121.

The CPT codes for 2012 are subject to the 90-day global period.

Working with your local insurance carrier may result in educating them about the procedure and supports work to obtain reimbursement for this approach to autologous skin grafting.

Download the complete Xpansion kit coding and reimbursement guide (PDF)

 

The above coding information is provided for information only. Reimbursement will vary based on insurance carrier. All of the CPT codes that describe the procedure may be included on an insurance claim provided all of the services are provided to the patient and supported by medical documentation found in the patient’s medical record.

Health economic and reimbursement information provided by SteadMed Medical is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. SteadMed Medical encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. SteadMed Medical recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters.

SteadMed Medical does not promote the use of its products outside their FDA- approved label.

Source CPT Codes 2011 AMA CPT Manual

CPT Disclaimer, American Medical Association (AMA) Notice and Disclaimer. CPT codes, descriptions and other data are copyright 2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, 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.

AMA CPT® 2012 Professional Edition

*CPT is a registered trademark of the American Medical Association.

All specific references to CPT (Current Procedural Terminology) terminology and phraseology are ©2012 American Medical Association. All rights reserved.

TOP