SurgiGRAFT-DUAL

Last updated on 1/21/24 | First published on 1/21/24 | Literature review current through Oct. 2024 [cite]

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Technology and Product Assessment

Product Type: Allogeneic matrix

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.

SurgiGRAFT-DUAL is a bilayer human amniotic tissue allograft.

INTENDED USES: SurgiGRAFT-DUAL is intended for use to repair or replace dermal tissue, including in the treatment of chronic, non-healing wounds including neuropathic ulcers, post-traumatic and pressure ulcers.

CLAIMED BENEFITS: The minimally-processed bilayer allograft contains collagen types IV, V, and VII that will promote cellular differentiation and wound healing. SurgiGRAFTDUAL is applied topically to chronic, non-healing wounds.

OPTION: It is available in sizes 2 x 2 cm, 2 x 3 cm, 2 x 4 cm, 2 x 8 CM, 4 x 4 cm; and 12 mm, 15 mm and 18 mm diameter rounds.

No SKU: SurgiGRAFT-DUAL, 2 x 2 cm: Q4219

No SKU: SurgiGRAFT-DUAL, 2 x 3 cm: Q4219

No SKU: SurgiGRAFT-DUAL, 2 x 4 cm: Q4219

No SKU: SurgiGRAFT-DUAL, 2 x 8 cm: Q4219

No SKU: SurgiGRAFT-DUAL, 4 x 4 cm: Q4219

No SKU: SurgiGRAFT-DUAL, 12 mm: Q4219

No SKU: SurgiGRAFT-DUAL, 15 mm: Q4219

No SKU: SurgiGRAFT-DUAL, 18 mm: Q4219

Manufacturer: Synergy Biologics, LLC.

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

SurgiGRAFT-DUAL, per square centimeter

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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

Synergy Biologics, LLC.
SurgiGRAFT-DUAL, per square centimeter

$.00

Coming soon

* 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.

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Product

Estimated
Out-of-pocket
Cost

Recom / Evidence

FDA Safety

Quality Measures

Cost Effectiveness

SurgiGRAFT-DUAL, per square centimeter

Coming soon

Product

Estimated
Out-of-pocket
Cost

Features

SurgiGRAFT-DUAL, per square centimeter

CPT Code	Description	Physician Reimbursement - Office	Physician Reimbursement - Facility	Facility Reimbursement
15271	Skin sub graft trnk/arm/leg	$159.88	$85.13	$1,749.26
15272	Skin sub graft t/a/l add-on	$25.95	$18.00
15273	Skin sub grft t/arm/lg child	$327.72	$201.41	$3,596.22
15274	Skn sub grft t/a/l child add	$86.86	$46.37
15275	Skin sub graft face/nk/hf/g	$164.38	$94.82	$1,749.26
15276	Skin sub graft f/n/hf/g addl	$33.57	$25.95
15277	Skn sub grft f/n/hf/g child	$359.56	$229.44	$1,749.26
15278	Skn sub grft f/n/hf/g ch add	$100.36	$57.79

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.

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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.

Topic 2336 Version 1.0

SurgiGRAFT-DUAL

SurgiGRAFT-DUAL

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