Wiki product vs application

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solocoder

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If a certain product (a bioengineered skin substitute) is not covered, is it OK to bill just the application code without the supply code? Or would the application also not be covered?
The application WOULD be covered, if a different product had been used.
 
On face value, I'd say the application could be billed. I compare it to wound repair, for example 12001 includes the repair and the closure material (eg, sutures). In your case, the material is not included in the repair/application which is what I based my opinion on...

But, I did a quick search about this in general and came up with quite a few LCDs that excluded both the material and the application, but it was dependent on the codes being used. What codes are you looking at for each?
 
solocoder said:
The application code for these is 15275 and this particular product is Q4104.
Click to expand...

Okay, well it looks like you have to report the product code with the application. Personally I'd submit the claim and see if I could at least get the application paid for...

Is the product not covered because it's statutorily or policy excluded? Or can you appeal for medical necessity?
 
It looks like the LCD was retired on 3/1/16 and there's no versions referenced. Is the DOS prior to that? Is WPS who you're billing to?
 
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