Hi Kim,

Which CTP are you inquiring about? Or are you needing general coding information for any CTP?

In general, right now it is for Puraply and Affinity?

Kim,
Your first step is to look at the LCD of your MAC...it can tell you what is and is not covered..
Cathy

Agree with Cathy that the first thing is to look at the LCD of your MAC.
Here you can find links to your LCDs (just click on the reference > view source, and you'll go straight to the LCD)
https://woundreference.com/app/topic?id=medicare-coverage-determinations-for-wound-care&find=wound+care+lcd#national-or-local-coverage-determinations

Tiff might have other important info to add. In the meantime, here is a section in our topic "Cellular and/or Tissue Based Products" that talks about coding, coverage and reimbursement in different care settings, including Qualified healthcare professional (QHP)’s office: https://woundreference.com/app/topic?id=cellular-andor-tissue-products&find=ctp#coding,-coverage-and-reimbursement

There is not a specific WPS LCD covering Cellular and/or Tissue Based Product, however, it is wise to refer to other LCDs as well. . When billing for CTP, the rules can be different depending on the place of service Clinic "place of service 11" or Outpatient Hospital "place of service 22". Below are the rules for POS 22
When billing for CTP application, the billing department will want to know which CTP product was applied, for example, PuraPly Q4195 1 sq cm OR PuraPly AM Q4196 1 sq cm

The billing department will also want to know what part of the body the CTP was placed as this will determine which application code will be billed. For example, if you use Puraply, the biller would bill for the Q- code (Q4195 or Q4196) and then one of the application codes depending on the location and amount of Puraply applied.
Application CPT ® Codes
Description
15271
Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq. cm or less of wound surface area
15272
each additional 25 sq. cm wound surface area, or part thereof (List separately in addition to code for primary procedure)
15273
Application of skin substitute graft to trunk, arms, legs, total wound surface greater than or equal to 100 sq. cm; first 100 sq. cm wound surface area, or 1% of body area of infants and children
15274
each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)
15275
Application of skin substitute graft to face, scalp, feet, etc., total wound surface area up to 100 sq. cm; first 25 sq. cm or less
15276
each additional 25 sq. cm wound surface area, or part thereof (List separately in addition to code for primary procedure)
15277
Application of skin substitute graft to face, scalp, feet, etc., total wound surface area greater than or equal to 100 sq. cm; first 100 sq. cm wound surface area, or 1% of body area of infants and children
15278
each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children) (List separately in addition to code for primary procedure)

In summary:
Bill the Q Code followed by the appropriate application code. The Q code identifies what CTP is used, but no payment is made on this code. The payment is applied to the application code so be sure to choose wisely in regards to location and amount used.
Be sure to bill for the entire amount or units of the CTP even if not all of it is applied to the wound.
You do not need to code wastage using the JW modifier but do need to document it in the patient's record.
Refer to the Wound Reference https://woundreference.com/app/topic?id=cellular-andor-tissue-products&find=cellular+tissue#coding,-coverage-and-reimbursement

Ensure the following minimally is documented:
Date, time and location of ulcer treated;
Name of skin substitute and how product supplied;
Amount of product unit used;
Amount of product unit discarded;
Reason for the wastage;
Manufacturer’s serial/lot/batch or other unit identification number of graft material. When manufacturer does not supply unit identification, record must document such.

Debridement prior to application of the CTP to prepare the wound bed is included in the payment for application of the skin graft and not separately payable. Refer to the NCCI Edits tool to see what procedures will pay when performed with CTP application

https://woundreference.com/app/topic?id=ncci-edits-for-hospital-and-physician-services-backup