Three Medicare Administrative Contractors (MACs) CGS Medicare, First Coast Service Option (FCSO) and Novitas issued their final Local Coverage Determinations (LCDs) for Cellular and/or tissue-based products (CTPs). These policies will go into effect on September 17, 2023.
Here’s the long list of CTPs that have been placed on the “non-covered” list by these 3 MACs:
- A2004 Xcellistem, 1 mg
- A2005 Microlyte matrix, per sq cm
- A2006 Novosorb synpath per sq cm
- A2014 Omeza collag per 100 mg
- Q4112 Cymetra injectable
- Q4113 Graftjacket xpress
- Q4114 Integra flowable wound matri
- Q4116 Alloderm
- Q4118 Matristem micromatrix
- Q4125 Arthroflex
- Q4126 Memoderm/derma/tranz/integup
- Q4130 Strattice tm
- Q4134 Hmatrix
- Q4135 Mediskin
- Q4137 Amnioexcel biodexcel 1sq cm
- Q4138 Biodfence dryflex, 1cm
- Q4139 Amnio or biodmatrix, inj 1cc
- Q4140 Biodfence 1cm
- Q4142 Xcm biologic tiss matrix 1cm
- Q4143 Repriza, 1cm
- Q4145 Epifix, inj, 1mg
- Q4146 Tensix, 1cm
- Q4149 Excellagen, 0.1 cc
- Q4150 Allowrap ds or dry 1 sq cm
- Q4155 Neoxflo or clarixflo 1 mg
- Q4157 Revitalon 1 square cm
- Q4159 Affinity1 square cm
- Q4160 Nushield 1 square cm
- Q4162 Wndex flw, bioskn flw, 0.5cc
- Q4165 Keramatrix, kerasorb sq cm
- Q4167 Truskin, per sq centimeter
- Q4168 Amnioband, 1 mg
- Q4169 Artacent wound, per sq cm
- Q4170 Cygnus, per sq cm
- Q4171 Interfyl, 1 mg
- Q4174 Palingen or promatrx
- Q4176 Neopatch or therion, 1 sq cm
- Q4177 Floweramnioflo, 0.1 cc
- Q4178 Floweramniopatch, per sq cm
- Q4180 Revita, per sq cm
- Q4181 Amnio wound, per square cm
- Q4182 Transcyte, per sq centimeter
- Q4183 Surgigraft, 1 sq cm
- Q4184 Cellesta or duo per sq cm
- Q4185 Cellesta flowab amnion 0.5cc
- Q4188 Amnioarmor 1 sq cm
- Q4189 Artacent ac, 1 mg
- Q4190 Artacent ac 1 sq cm
- Q4192 Restorigin, 1 cc
- Q4194 Novachor 1 sq cm
- Q4195 Puraply 1 sq cm
- Q4196 Puraply am 1 sq cm
- Q4197 Puraply xt 1 sq cm
- Q4198 Genesis amnio membrane 1sqcm
- Q4199 Cygnus matrix, per sq cm
- Q4201 Matrion 1 sq cm
- Q4202 Keroxx (2.5g/cc), 1cc
- Q4204 Xwrap 1 sq cm
- Q4205 Membrane graft or wrap sq cm
- Q4206 Fluid flow or fluid gf 1 cc
- Q4208 Novafix per sq cm
- Q4209 Surgraft per sq cm
- Q4210 Axolotl graf dualgraf sq cm
- Q4211 Amnion bio or axobio sq cm
- Q4212 Allogen, per cc
- Q4213 Ascent, 0.5 mg
- Q4214 Cellesta cord per sq cm
- Q4215 Axolotl ambient, cryo 0.1 mg
- Q4217 Woundfix biowound plus xplus
- Q4218 Surgicord per sq cm
- Q4219 Surgigraft dual per sq cm
- Q4220 Bellacell hd, surederm sq cm
- Q4221 Amniowrap2 per sq cm
- Q4224 Hhf10-p per sq cm
- Q4225 Amniobind, per sq cm
- Q4226 Myown harv prep proc sq cm
- Q4227 Amniocore per sq cm
- Q4229 Cogenex amnio memb per sq cm
- Q4230 Cogenex flow amnion 0.5 cc
- Q4231 Corplex p, per cc
- Q4232 Corplex, per sq cm
- Q4233 Surfactor /nudyn per 0.5 cc
- Q4234 Xcellerate, per sq cm
- Q4235 Amniorepair or altiply sq cm
- Q4236 Carepatch per sq cm
- Q4237 Cryo-cord, per sq cm
- Q4239 Amnio-maxx or lite per sq cm
- Q4240 Corecyte topical only 0.5 cc
- Q4241 Polycyte, topical only 0.5cc
- Q4242 Amniocyte plus, per 0.5 cc
- Q4244 Procenta, per 200 mg
- Q4245 Amniotext, per cc
- Q4246 Coretext or protext, per cc
- Q4247 Amniotext patch, per sq cm
- Q4248 Dermacyte amn mem allo sq cm
- Q4249 Amniply, per sq cm
- Q4250 Amnioamp-mp per sq cm
- Q4251 Vim, per square centimeter
- Q4252 Vendaje, per square centimet
- Q4253 Zenith amniotic membrane psc
- Q4254 Novafix dl per sq cm
- Q4255 Reguard, topical use per sq
- Q4256 Mlg complet, per sq cm
- Q4257 Relese, per sq cm
- Q4258 Enverse, per sq cm
- Q4259 Celera per sq cm
- Q4260 Signature apatch, per sq cm
- Q4261 Tag, per square centimeter
- Q4262 Dual layer impax, per sq cm
- Q4263 Surgraft tl, per sq cm
- Q4264 Cocoon membrane, per sq cm
- Q4265 Neostim tl per sq cm
- Q4266 Neostim per sq cm
- Q4267 Neostim dl per sq cm
- Q4268 Surgraft ft per sq cm
- Q4269 Surgraft xt per sq cm
- Q4270 Complete sl per sq cm
- Q4271 Complete ft per sq cm
- Q4272 Esano a, per sq cm
- Q4273 Esano aaa, per sq cm
- Q4274 Esano ac, per sq cm
- Q4275 Esano aca, per sq cm
- Q4276 Orion, per sq cm
- Q4277 Woundplus e-grat, per sq cm
- Q4278 Epieffect, per sq cm
- Q4280 Xcell amnio matrix per sq cm
- Q4281 Barrera slor dl per sq cm
- Q4282 Cygnus dual per sq cm
- Q4283 Biovance tri or 3l, sq cm
- Q4284 Dermabind sl, per sq cm
Links to the articles:
- Article – Billing and Coding: Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (A57680) (cms.gov)
- Article – Billing and Coding: Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (A54117) (cms.gov)
- Article – Billing and Coding: Skin Substitutes Grafts/Cellular Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (A56696) (cms.gov)
