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Thread: Biologics

  1. #1

    Default Biologics

    AAPC: Back to School
    Can anyone help me with the billing guidelines for Apligraf HCPCS Q4101? Nedd some info for a job interview.

  2. #2
    Join Date
    Apr 2007
    Temple, TX


    This link may have what you are looking for:


    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.

    Apligraf® (Q4101) Indications:

    Neuropathic diabetic foot ulcer.
    Venous stasis ulcer.
    Apligraf® (Q4101) Limitations:

    Medicare payment for Apligraf® is limited to five applications per ulcer, though more than three applications of Apligraf® to a single wound are usually unnecessary.
    Medicare does not cover continued reapplication of Apligraf® 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.
    Last edited by MJ4ever; 05-23-2011 at 10:33 AM.
    The Oracle

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