Health Information Management

Tip: CMS adds high-cost skin substitute product codes

APCs Insider, June 27, 2014

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The April I/OCE update brought changes to the packaging of skin substitutes that was introduced in the 2014 OPPS final rule. In the final rule, CMS created two groups for packaging:
  • High-cost skin substitutes having a weighted average cost greater than $32 per sq cm
  • Low-cost skin substitutes having a weighted average cost less than $32 per sq cm
As part of the April update, CMS added three high-cost skin substitute products, effective April 1:
  • Q4121, TheraSkin®
  • Q4147, architect extracellular matrix, per sq cm
  • Q4148, Neox™ 1k, per sq cm
Q4121 is a new code and is assigned status indicator G, meaning that unlike the other codes added to the high-cost category, it has pass-through status and a separate payment may be provided with an offset for applying it. Q4147 and Q4148 have been moved from the low-cost category.
 
This tip is adapted from “CMS refines skin substitute packaging” in the June issue of Briefings on APCs.



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