Health Information Management

Tip: CMS moves skin substitutes from low- to high-cost category

APCs Insider, March 20, 2015

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In 2014, CMS added skin substitutes to the list of packaged drugs and biologicals, dividing the products into low- and high-cost categories. Since then, CMS has continued to update the categories with new products and codes, with several changes effective January 1.
CMS moved the following HCPCS codes from the low-cost to the high-cost category:
  • C9363, Integra™ meshed bilayer wound matrix, per square centimeter
  • Q4104, Integra bilayer matrix wound dressing, per square centimeter
  • Q4105, Integra dermal regeneration template, per square centimeter
  • Q4108, Integra matrix, per square centimeter
  • Q4123, Alloskin™ RT, per square centimeter
  • Q4128, FlexHD®, AlloPatch HD™, or Matrix HD, per square centimeter
  • Q4129, Unite® Biomatrix, per square centimeter
All of these skin substitute product codes are assigned status indicator N (no additional payment, payment included in line items with APCs for incidental service) and will continue to be packaged with no offset amount to be applied.
This tip is adapted from “CMS adds comprehensive APC logic in January quarterly I/OCE update" in the March issue of Briefings on APCs.

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