Skin Substitutes and Wound Care Products Billing Reminder

CMS provides pricing for some wound care products; however, there are many that do not have established pricing. If a skin substitute/wound care product does not have established pricing, the pricing for the item will be dependent on the cost of the item provided for patient care.

When billing Medicare for those products, you must provide an invoice price or acquisition cost for that item. For some products, such as Q4010 which is a not otherwise specified code and codes for products that vary in size, the size of the product is needed.

In order to price appropriately we require the invoice price or acquisition cost and the total size of the product being used. That may be provided in the electronic comment screen of the claim form in the NTE Segment of Loop 2400 for the claim line indicated by the product.

As an additional reminder, the amount must match the size type indicated by the code. If the code is defined as per square centimeter, the units billed must match the size billed in square centimeters. For example, Q4101-Q4226 are coded as per square centimeter. If you have a product that is 4x4 square centimeters, you would enter as 16 units.

Posted 5/11/2020