| New |
| Code |
Description |
| G0456 |
Negative pressure wound therapy, (e. G. Vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters |
| G0457 |
Negative pressure wound therapy, (e. G. Vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters |
| Q4131 |
Epifix, per square centimeter |
| Q4132 |
Grafix core, per square centimeter |
| Q4133 |
Grafix prime, per square centimeter |
| Q4134 |
Hmatrix, per square centimeter |
| Q4135 |
Mediskin, per square centimeter |
| Q4136 |
Ez-derm, per square centimeter |
| C9349 |
Fortaderm, and fortaderm antimicrobial, any type, per square centimeter |
| G9649 |
Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (PGA; 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or der life quality index) (DLQI)) |
| G9650 |
Documentation that the patient declined therapy change or has documented contraindications (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by PGA, BSA, PASI, or DLQI |
| G9651 |
Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (PGA; 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or der life quality index) (DLQI)) or psoriasis assessment tool not documented |
| G9652 |
Patient has been treated with a systemic or biologic medication for psoriasis for at least six months |
| G9653 |
Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months |
| J2407 |
Injection, oritavancin, 10 mg |
| J3090 |
Injection, tedizolid phosphate, 1 mg |
| Q4161 |
Bio-ConneKt wound matrix, per square centimeter |
| Q4162 |
AmnioPro flow, BioSkin flow, BioRenew flow, WoundeEx flow, amniogen-a, amniogen-c, 0.5 cc |
| Q4163 |
AmnioPro, BioSkin, BioRenew, WoundEx, Amniogen-45, Amniogen-200, per square centimeter |
| Q4164 |
Helicoll, per square centimeter |
| Q4165 |
Keramatrix, per square centimeter |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
| G9682 |
This code is for the onsite acute care treatment a nursing facility resident with a skin infection; may only be billed once per day per beneficiary |
| G9764 |
Patient has been treated with an oral systemic or biologic medication for psoriasis |
| G9765 |
Documentation that the patient declined therapy change, has documented contraindications, or has not been treated with an oral systemic or biologic for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi |
| Q4166 |
Cytal, per square centimeter |
| Q4167 |
Truskin, per square centimeter |
| Q4168 |
Amnioband, 1 mg |
| Q4169 |
Artacent wound, per square centimeter |
| Q4170 |
Cygnus, per square centimeter |
| Q4171 |
Interfyl, 1 mg |
| Q4172 |
Puraply or puraply am, per square centimeter |
| Q4173 |
Palingen or palingen xplus, per square centimeter |
| Q4174 |
Palingen or promatrx, 0.36 mg per 0.25 cc |
| Q4175 |
Miroderm, per square centimeter |
| Q5102 |
Injection, infliximab, biosimilar, 10 mg |
| C9015 |
Injection, c-1 esterase inhibitor (human), haegarda, 10 units |
| C9029 |
Injection, guselkumab, 1 mg |
| J3358 |
Ustekinumab, for intravenous injection, 1 mg |
