CPT 15271 using Porcine Xenoograft


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Hello and thank you for reading.... I am having trouble with Medicare and Private carriers regarding the CPT 15271. Just this year the started to deny. My manager has asked that I re-bill with a Q4102, an if that doesn't work use, Q4133. Kinda of in a pinch, told to do something one way, when not given the options to look on my own. Any help would be great!! Thank you


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What product is being used, and in what place of service, and what denial are you receiving for this? Q4133 and Q4102 are not interchangeable - Q4133 is for Grafix Prime and Q4102 is for Oasis; you should only bill the code that reflects what was actually used. 15271 would be an appropriate code for application of either of these two products, (unless you're billing for a facility, in which case you may need to use C5271 with the Oasis product since is falls under low cost skin substitute in the facility reimbursement). There are LCDs in place for both of these, which you may want to review for your payers as well - there are a limited number of diagnosis codes for which these products are approved for payment.