Health Information Management

Q&A: Did CMS change its packaging of skin substitutes in the latest OPPS update?

APCs Insider, April 11, 2014

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Q: Did CMS make any changes to the packaging of skin substitutes in the latest OPPS update? Some of these are really expensive and were assigned to the low-cost category.
 
A: CMS made no alterations to the packaging policy for skin substitutes. CMS noted in the OPPS final rule that it used the July 2013 payment rate of $32 as the threshold for categorizing the skin substitutes.
Those with payment rates higher than $32 were assigned to the high-cost category and those with payment rates less than $32 to the low-cost category. Any skin substitutes that didn't have pricing information were assigned to the low-cost category until cost information became available.  

For the April 2014 OPPS update, CMS has cost data for three skin substitutes. Two have been reclassified to the high-cost group; the third remains in the low-cost group.
  • Q4143 (Repriza®, per square centimeter) remains assigned to the low-cost category
  • Q4147 (Architect Extracellular Matrix, per square centimenter) moves to the high-cost category
  • Q4148 (Neox® 1k, per square centimeter) moves to the high-cost category

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman and founder of Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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