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Ohio Part B Carrier
Skin Substitutes for Wound Healing: Coverage

The 2009 Healthcare Common Procedure Coding System (HCPCS) code Annual Update includes a new code series, Q4100 through Q4114, effective January 1, 2009, to identify skin substitute products. The Local Coverage Determination (LCD), Skin Substitutes for Wound Healing, was retired on January 1, 2009. Effective for dates of service on or after January 1, 2009, please use the following codes and descriptions.

HCPCS Code
Description
Q4100
Skin substitute, not otherwise specified
Q4101
Skin substitute, Apligraf, per square centimeter
Q4102
Skin substitute, Oasis wound matrix, per square centimeter
Q4103
Skin substitute, Oasis burn matrix, per square centimeter
Q4104
Skin substitute, Integra bilayer matrix wound dressing (BMWD), per square centimeter
Q4105
Skin substitute, Integra dermal regeneration template (DRT), per square centimeter
Q4106
Skin substitute, Dermagraft, per square centimeter
Q4107
Skin substitute, Graftjacket, per square centimeter
Q4108
Skin substitute, Integra matrix, per square centimeter
Q4109
Skin substitute, Tissuemend, per square centimeter
Q4110
Skin substitute, Primatrix, per square centimeter
Q4111
Skin substitute, Gammagraft, per square centimeter
Q4112
Allograft, Cymetra, injectable, 1cc
Q4113
Allograft, Graftjacket express, injectable, 1cc
Q4114
Allograft, Integra flowable wound matrix, injectable, 1cc
 
The HCPCS codes J7340 through J7350 and C9357 were discontinued on December 31, 2008.
 
Effective January 1, 2009, HCPCS codes Q4100 through Q4114 require one of the following HCPCS Modifiers.
 
HCPCS Modifier
Description
JC
Skin substitute used as a graft
JD
Skin substitute not used as a graft
 

 

last updated on 04/14/2009