INDICATIONS FOR USE
Partial and Full
Thickness Wounds
Draining
Wounds
Tunneling
Wounds
Pressure
Sores/Ulcers
Venous
Ulcers
Post Moh’s
Surgery
Diabetic
Ulcers
Trauma
Wounds
Surgical
Wounds
2024 Medicare Physician Office Reimbursement
PRODUCT CODE | DESCRIPTION |
---|---|
04161 | bio-ConneKt per cm2 |
QCODE | CATALOG NUMBER | SIZE | BILLING UNITS |
---|---|---|---|
Q4161 | 1101-1515 | 1.5cm x 1.5cm | 2 |
Q4161 | 1101-0202 | 2cm x 2cm | 4 |
Q4161 | 1101-0303 | 3cm x 3cm | 9 |
Q4161 | 1101-0404 | 4cm x 4cm | 16 |
Q4161 | 1101-0505 | 5cm x 5cm | 25 |
Q4161 | 1101-0607 | 6cm x 7cm | 42 |
Q4161 | 1101-0126 | 6cm x 21cm | 126 |
APPLICATION CODE |
DESCRIPTION | NATIONAL PHYSICIAN RATE IN OFFICE |
---|---|---|
15271 | Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100cm2; first 25 cm2 or less wound surface area |
$152 |
15271 | Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100cm2; first 25 cm2 or less wound surface area, or part thereof (List separately in addition to code for primary procedure) | $24 |
15271 | 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 100cm2; first 25cm2 or less wound surface area. | $157 |
15271 | Application of skin substitue graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 cm2; each additional 25 cm2 wound surface area, or part thereof (List separately in addition to code for primary procedure) | $32 |
Billling Examples
BILLING CONSIDERATIONS
- Debridement is considered a component of the application code.
- Minimal wound preparation is considered part of the application.
- Only 1 primary application code can be billed even if you have multiple wounds for similar anatomic locations (e.g., trunk, arms, leg). Select the code that represents the total of all wounds for that anatomical grouping. Bill the total units for the product.
- The application code is based on wound size and the product code is based on product size. Healthcare Professionals should use the appropriate size product for the wound size to minimize wastage.
BIO-CONNEKT 2CM x 2CM SHEET APPLIED
BILLING CODE |
CODE DESCRIPTION |
BILLING UNITS* |
CO-PAYMENT | MEDICARE ALLOWABLE** |
MEDICARE PAYMENT (80%) |
SECONDARY PAYMENT (20%) |
---|---|---|---|---|---|---|
15275 | Application | 1 | 20% | $157 | $126 | $31 |
Q4161 | 4 | 20% | 4 X $2060-8,240 | $6,592 | $1,648 | |
TOTAL | $8,397 | $6,718 | $1,679 |
BIO-CONNEKT 4CM x 4CM SHEET APPLIED
BILLING CODE |
CODE DESCRIPTION |
BILLING UNITS* |
CO-PAYMENT | MEDICARE ALLOWABLE** |
MEDICARE PAYMENT (80%) |
SECONDARY PAYMENT (20%) |
---|---|---|---|---|---|---|
15271 | Application | 1 | 20% | $152 | $122 | $30 |
Q4161 | 16 | 20% | 16 X $2,060-32,960 | $26,368 | $6,592 | |
TOTAL | $33,112 | $26,490 | $6,622 |
The following grid provides guidance on billing skin substitute application procedure codes by wound size and anatomical location. For ex ample, a 53 cm2 wound on the leg should be billed with 1 unit of 15271 and 2 unite of 15272. Add-on codes(+) cannot be billed alone. In addition to the procedure code,the product code (Q4161) should be billed with the total units of the product. Reference the bio-ConneKt sizes grid on page 1 to determine billing units by product size.
*Units for sizes are rounded up per Medicare guidelines.** National Medicare 2024 Payment Rate based on 2024 Physician Fee Schedule Relative Value File.The bio-ConneKt rate is based on the Q1 2024 Medicare Part B Drug File. Each facility rate will vary based on its Geographic Practice Cost Index (GPCI). The calculations do not include the 2% sequestration.
1-25cm2 | 15271 | 15275 |
26-50cm2 | +15272 X 1 | +15276 X 1 |
51-75cm2 | +15272 X 2 | +15276 X 2 |
76-99cm2 | +15272 X 3 | +15276 X 3 |
100cm2 | 15273 | 15277 |
101-200cm2 | +15274 X 1 | +15278 X 1 |
201-300cm2 | +15274 X 2 | +15278 X 2 |
301-400cm2 | +15274 X 3 | +15278 X 3 |