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The following indications and limitations to Medicare coverage and payment apply to the specified bioengineered skin substitutes and their related skin substitute application physician services.
ApligrafÂ® (Q4101) Indications:
Neuropathic diabetic foot ulcer.
Venous stasis ulcer.
ApligrafÂ® (Q4101) Limitations:
Medicare payment for ApligrafÂ® is limited to five applications per ulcer, though more than three applications of ApligrafÂ® to a single wound are usually unnecessary.
Medicare does not cover continued reapplication of ApligrafÂ® when the treatment is unsuccessful after 30 days of treatment.
Medicare does not cover retreatment of an ulcer following an unsuccessful course of treatment.
Medicare does not cover retreatment of a successfully treated, healed ulcer.
See “Coding Guidelines” regarding required use of the KX modifier with Q4101, Q4102, Q4106, Q4107 and 15330–15431 and G0440-G0441 to report skin substitute products that have been handled, applied and immobilized appropriately and according to manufacturers’ label instructions.
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