Question Application of free (pro bono) skin substitutes for Medicare.

mayra.zambrano

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I work for a wound care clinic that applies free samples given to us by pharmaceutical rep to patients. I wanted to know if there's a way to receive reimbursement from Medicare for the application only. If so, how would I bill this? I attended a seminar that stated that modifier "FB" was required to indicate that we are billing the application for a free product. Once billed the claim is denied stating that we used an invalid modifier.
 
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Oakland, CA
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Hi there: Actually, modifier FB is intended for Hospital Outpatient Claims subject to the Outpatient Prospective Payment System (OPPS). This modifier should always be used with procedures or devices. The codes that come immediately to mind are those involving Adjacent Tissue Transfers or defect repairs with rotational advancement flaps or better yet, skin grafts. It would be reported on the same line as the procedure. Also, this is not a paid modifier. It is informational and applies to items that are covered without cost to the provider. I hope that helps!
 

KIANSW123

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Worcester, MA
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would anyone know how to report a free skin substitute that was applied in an office setting (POS11)? would we just report the CPT (15271) and the product -Q4100 at 0.00 (or 0.01) charge?
 

mayra.zambrano

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would anyone know how to report a free skin substitute that was applied in an office setting (POS11)? would we just report the CPT (15271) and the product -Q4100 at 0.00 (or 0.01) charge?
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That's what we're doing but only 1 insurance is reimbursing use for the application of free product, no one else is. Aetna is the only one.
 

mayra.zambrano

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Location
Fort Worth, TX
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Hi there: Actually, modifier FB is intended for Hospital Outpatient Claims subject to the Outpatient Prospective Payment System (OPPS). This modifier should always be used with procedures or devices. The codes that come immediately to mind are those involving Adjacent Tissue Transfers or defect repairs with rotational advancement flaps or better yet, skin grafts. It would be reported on the same line as the procedure. Also, this is not a paid modifier. It is informational and applies to items that are covered without cost to the provider. I hope that helps!
So in other words when we apply a free skin substitute, we should not expect to receive reimbursement from the insurance company for the application?
 
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