Professional Resources Patient/Caregiver Resources

Association for the Advancement of Wound Care Alert CPT Codes and Therapy Caps 2011

New Proposed CPT® Codes for the Application of Dermagraft® and Apligraf® for the Lower Extremity

In the Medicare Proposed Rule for the 2011 Physician Fee Schedule (PFS), CMS has
proposed to issue two new HCPCS codes for the application of Apligraf® and Dermagraft® to the lower limb.

The codes will be used for either product and will include the debridement associated with
the application.

In addition, under the PFS, as a temporary measure, the HCPCS G-codes would be
assigned a 0-day global period.

GXXX1 (Application of tissue cultured allogeneic skin substitute or dermal substitute;

for use on lower limb, includes the site preparation and debridement if performed; first 25 sq cm or less) andGXXX2 (Application of tissue cultured allogeneic skin or dermal substitute; for use on
lower limb, includes the site preparation and debridement if performed; each additional 25 sq cm)

These codes would be recognized for payment under the PFS for the application of either
Apligraf® or Dermagraft® to the lower limb.

CMS is proposing to base payment on the existing physician work relative values and the directPE inputs for the existing CPT codes for Apligraf® application, with adjustments for theglobal period differences.

Their adjustments result in a proposed CY 2011 work RVU of:

Work RVU 2.22 for GXXX1
Work RVU 0.50 for GXXX2

ALERT – Cap amounts for therapy services in 2011

MLN Matters® Number: MM7170 Related Change Request Number: 7170
Medicare has announced the 2011 Therapy Caps limits for 2011, which are set at $1870.
The exceptions process will continue unchanged for the time frame directed by the Congress.

The limitations apply to outpatient services and do not apply to Skilled Nursing Facility (SNF) residents in a covered Part A stay, including swing beds.
Rehabilitation services are included within the global Part A per diem payment that the SNF receives under the prospective payment system (PPS) for the covered stay.
Limitations do not apply to any therapy services billed under the Home Health PPS, inpatient hospitals or the outpatient department of hospitals, including critical access hospitals.

Disclaimer

While AAWC makes every effort to present accurate and reliable information on this website, AAWC does not endorse, approve, or certify such information, nor does it guarantee the accuracy, completeness, efficacy, timeliness, or correct sequencing of such information. Use of any information found on this website is voluntary. Reference on this website to any specific commercial product, process or service by trade name, trademark, service mark, manufacturer, and corporation or otherwise does not constitute or imply endorsement, recommendation, or favoring by AAWC.

AAWC (including its employees and agents) assumes no responsibility for consequences resulting from the use of the information found on this site (or from the use of the information obtained at linked internet addresses), or in any respect for the content of such information, including (but not limited to) errors or omissions, the accuracy or reasonableness of factual or scientific assumptions, studies or conclusions, the defamatory nature of statements, ownership of copyright or other intellectual property rights, and the violation of property, privacy, or personal rights of others. AAWC is not responsible for, and expressly disclaims all liability for, damages of any kind arising out of use, reference to, or reliance on such information.