Wiki High Cost Skin Substitute

[serena0729]

Is there a generic HCPCS code for high cost skin allograft, similar to Q4100, for low cost skin substitute?

 

[thomas7331]

A4100 is the NOS code for any skin substitute that doesn't have an assigned HCPCS code, it's not just for the so-called low-cost skin substitutes. CMS has proposed that code to reimburse as a low-cost substitute under OPPS for 2023, so that's what you'd have to use if the product your provider is using doesn't have a specific HCPCS code. CMS doesn't give providers the option of deciding on their own whether a particular product should be high- or low-cost.

 

[Mrsrpc]

A4100 is the NOS code for any skin substitute that doesn't have an assigned HCPCS code, it's not just for the so-called low-cost skin substitutes. CMS has proposed that code to reimburse as a low-cost substitute under OPPS for 2023, so that's what you'd have to use if the product your provider is using doesn't have a specific HCPCS code. CMS doesn't give providers the option of deciding on their own whether a particular product should be high- or low-cost.

Exactly. It's up to the manufacturer to apply for a more specified code that would cover the higher cost if the product, indeed, warrants it. It's not an easy battle. That's the work I do. So, those higher-ticket items would just be absorbed into the cost of the procedure (at a loss for the provider) for now...