Last updated on 10/1/23 | First published on 10/20/17 | Literature review current through Mar. 2024
[cite]
For full access to this topic and more
premium content, upgrade today. Or browse to enjoy free content and tools.
Unbiased information for educational purposes only. WoundReference does not produce, market, advertise, re-sell or distribute healthcare goods or services consumed by, or used on patients. For information about specific products, please contact the manufacturer directly.
GammaGraft™ is an irradiated, sterile human skin allograft.
INTENTED USE: Used as a temporary skin graft on burns and chronic wounds.
CLAIMED BENEFITS: storable at room temperature. Pre-hydrated, no washing or preparation required before usage. It has a natural keratin layer that acts as a vapor barrier for the wound, which allows for moist wound healing and a moist wound bed, even though the allograft is dry. Sutures may be applied to fix the allograft.
Manufacturer: Promethean LifeSciences, Inc.
Information retrieved from manufacturer and/or FDA-approved labels
* Wound Reference does not produce, market, re-sell or distribute health care goods or services consumed by, or used on, patients. The product information contained on this page, including the product images and additional product materials, was collected from various supplier sources. All product claims and specifications are those of the product suppliers. Every effort has been made to ensure the accuracy of the product information, however on occasion manufacturers may alter their products or packaging without notice. Wound Reference assumes no liability for inaccuracies or misstatements about products. The properties of a product may change or be inaccurate following the posting or printing of the product information in the document, either in the print or online version. Due to product changes, information listed in this document is subject to change without notice. We recommend that you always read labels, warnings and instructions for use before using a product. Content on this site is for reference purposes and is not intended to be a substitute for professional advice given by a physician or other licensed healthcare professional.
ESSENTIALS
Product
Estimated
Out-of-pocket
Cost
HCPCS Class
HCPCS
Gammagraft, per square centimeter
Q4111
* Hover on the information button next to each header for detailed explanation on the type of information provided by the table
Select your state for Medicare
DME coverage and co-payment
Product
Estimated
Out-of-pocket
Cost
Patient DME Co-Payment per Billable Unit
DME Reimbursement to Suppliers
Frequency Replacement if Requirements Met
Office and/or Facility - Product reimbursement
$.00
per square centimeter (non-DMEPOS)
See Coding, Coverage and Reimbursement
$6.90
* Every effort has been made to ensure the accuracy of the product information, however you should visit the manufacturer's website for the latest information.
* Hover on the information button next to each header for detailed explanation on the type of information provided by the table
Product
Estimated
Out-of-pocket
Cost
Recom / Evidence
FDA Safety
Quality Measures
Cost Effectiveness
Product
Estimated
Out-of-pocket
Cost
Composition: Human dermis with/without epidermis
Configuration: Sheet
May apply on full-thickness wounds
May apply over exposed tendon/ bone/ muscle
Processing: Decellularized or irradiated
Processing: Hydrated
Processing: Minimally manipulated
Storage: room temp
| CPT Code | Description |
Physician Reimbursement - Office
|
Physician Reimbursement - Facility
|
Facility Reimbursement
|
| C5271 | Low cost skin substitute app |
|
|
$534.89
|
| C5273 | Low cost skin substitute app |
|
|
$1,749.26
|
| C5274 | Low cost skin substitute app |
|
|
|
| C5275 | Low cost skin substitute app |
|
|
$534.89
|
| C5272 | Low cost skin substitute app |
|
|
|
| C5276 | Low cost skin substitute app |
|
|
|
| C5277 | Low cost skin substitute app |
|
|
$534.89
|
| C5278 | Low cost skin substitute app |
|
|
|
- Based on national averages
- Medicare payments for participating qualified health professionals (QHP) for services performed in their Offices (*) or at a Facility (** i.e., hospital outpatient department or ambulatory service center). Payments are nationally unadjusted average amounts, and do not account for differences in payment due to geographic variation. The allowed rate for non-participating physicians is set at 95% of the allowable for participating physicians. Non-participating physicians are subject to the limiting charge rules. The coinsurance is limited to 20% of the allowable fee.
- When covered by the Medicare contractor, this manufacturer product is separately payable in a QHP office based on the Average Sales Price (ASP) as reported by the manufacturer on a quarterly basis.
- Hover on the information button next to each header for detailed explanation on the type of information provided by the table
- The information provided on this website is informational only. This is not a guarantee of Reimbursement Rates, nor is it intended to make recommendations regarding clinical practices. Information on this website is subject to change with out notice due to changes in reimbursement laws, regulations, rules and policies. The ultimate responsibility for correct coding lies with the provider of services. Please contact the appropriate payer for their interpretation of the appropriate code to use for the procedure.
- CPT® is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2018, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Codes referenced on Wound Reference are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage. Providers should reference the American Medical Association prior to the submission of claims for reimbursement of covered services.
* Scroll table to see all products.
CLINICAL
Indications
For homologous use in:
- Venous Stasis Ulcers
- Diabetic Foot Ulcers
- Full Thickness Ulcers
- Mohs Surgery Sites
- Skin Graft Donor Sites
- Areas of Dermabrasion
- Partial Thickness Burns
- Partial Thickness Wounds
- Temporary Coverage for Exposed Abdominal Viscera including Small Bowel and Liver
- Exposed Pericranium and Cranium
- Fasciotomy Sites
- Areas of Excision which are not closed pending final pathology report
FDA
Regulated under PHS 361 [21 CFR 1270 & 1271]: Human cells, tissues, and cellular and tissue-based products. Creates a unified registration and listing system for establishments that manufacture HCT/Ps and establishes donor eligibility, current good tissue practice, and other procedures to prevent the introduction, transmission, and spread of communicable diseases by HCT/Ps. Among other criteria, HCT/Ps are required to be minimally manipulated and intended for homologous use. Homologous use means the repair, reconstruction, replacement, or supplementation of a recipient’s cells or tissues with an HCT/P that performs the same basic function or functions in the recipient as in the donor. The basic functions of skin include covering, protecting the body from external force, and serving as a water-resistant barrier to pathogens or other damaging agents in the external environment. The dermis is the elastic connective tissue layer of the skin that covers, provides support and protects the body from mechanical stress. Human skin allografts used for supplemental support, protection, reinforcement, or covering for wounds, tendon, muscle, bones are considered homologous use. [1]
How supplied
- GG 100: 1(1/2)cmx1(1/2)cm.
- GG 225: 2(1/2)cmx3cm.
- GG 400: 4cmx4(1/2)cm.
- GG 625: 5cmx12cm, 7cmx8cm.
CODING, COVERAGE AND REIMBURSEMENT
This section currently focuses primarily on Medicare. It may be expanded in the future to include information on private insurers as well.
Medicare hospital outpatient prospective payment system (OPPS) cost category assignment:
Frequency of replacement allowed by Medicare:
| Medicare Administrative Contractor (MAC) |
Frequency of replacement if requirements met |
| Novitas Solutions, Inc. |
10 units in 12 weeks
|
| CGS Administrators, LLC |
10 units in 12 weeks
|
| First Coast Service Options, Inc. (FCSO) |
10 units in 12 weeks
|
|
Palmetto
Noridian
Wisconsin Physicians Service Insurance Corporation (WPS)
National Government Services, Inc. (NGS)
|
Carrier discretion
|
More details on requirements, medical necessity and documentation in specific Medicare Local Coverage Determinations (if available). See section on Coding, Coverage and Reimbursement in topic "Cellular and/or Tissue Products".
Official reprint from WoundReference® woundreference.com ©2024 Wound Reference, Inc. All Rights Reserved
Use of WoundReference is subject to the
Subscription and License Agreement.
NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.
