Apligraf® coding support.
This section contains suggested billing codes for Apligraf. These codes are provided for your information only. We always recommend that you check with your local carrier, Fiscal Intermediary (FI), Medicare Administrative Contractor (MAC), or other payer to verify coding and billing requirements.
| Type of code/service rendered | Code | Description |
|---|---|---|
| Apligraf | Q4101 | Apligraf per sq cm |
HCPCS © 2020 American Medical Association. All Rights Reserved.
*These codes are provided for your information only. Use of these codes is not a guarantee of payment. You should select the most appropriate code for the procedure performed. Coding practice will vary by site of care, patient condition, range of services provided, local carrier instructions, and other factors. Most MACs have established specific policies for office claims including payment for Apligraf along with the professional service component. Coding requirements are subject to change at any time. Check with your local payer or call the Apligraf hotline at 1-888-HEAL-2-DAY (select option 3) if you require additional information.
| Type of code/service rendered | Code | Description |
|---|---|---|
| Hospital Cost Center/Revenue Code | 636 | Drugs requiring detailed coding |
| 270 | Medical/surgical supplies and devices | |
| 272 | Sterile supply | |
| 274 | Prosthetic/orthotic devices | |
| 278 | Other implants | |
| 250 | General pharmacy | |
| 360 | Operating room services | |
| 510 | Clinic |
CPT © 2020 American Medical Association. All Rights Reserved.
*These codes are provided for your information only. Use of these codes is not a guarantee of payment. You should select the most appropriate code for the procedure performed. Coding practice will vary by site of care, patient condition, range of services provided, local carrier instructions, and other factors. Most MACs have established specific policies for office claims including payment for Apligraf along with the professional service component. Coding requirements are subject to change at any time. Check with your local payer or call the Apligraf hotline at 1-888-HEAL-2-DAY (select option 3) if you require additional information.
| Code | 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 wound surface area |
| 15272 | Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; 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 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 |
| 15274 | Each additional 100 sq cm wound surface area, 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, 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, or part thereof, or each additional 1% of body area of infants and children (list separately in addition to code for primary procedure) |
CPT © 2020 American Medical Association. All Rights Reserved.
*These codes are provided for your information only. Use of these codes is not a guarantee of payment. You should select the most appropriate code for the procedure performed. Coding practice will vary by site of care, patient condition, range of services provided, local carrier instructions, and other factors. Most MACs have established specific policies for office claims including payment for Apligraf, along with the professional service component. Coding requirements are subject to change at any time. Check with your local payer or call the Apligraf Reimbursement Hotline at 1-888-432-5232 (select option 3) if you require additional information.
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