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CPT codes for Skin Substitutes (Apligraf, Oasis wound matrix, Dermagraft, Primatrix)


The following Skin Substitutes are covered under Medicare in place of service inpatient hospital, outpatient hospital, ambulatory surgical center, or office setting:

Q4101 Skin substitute, apligraf, per square centimeter

Dermal and epidermal, (substitute) tissue of human origin, with or without bioengineered or processed elements, with metabolically active elements, per square centimeter

1. This product is a manufactured viable bilaminate graft or skin substitute designed to be used for treatment of non-infected, partial, and full thickness skin ulcers due to venous insufficiency or neuropathic diabetic foot ulcers.

2. For any product appropriately billed under this code, there must be documentation that the FDA labeling instructions including at least the criteria, frequency and acceptable duration of treatment were followed.

3. If the skin product is going to be billed to Medicare Part B, it must be billed on the same claim as the surgical application of the product.

Q4102 Skin substitute, oasis wound matrix, per square centimeter

Dermal (substitute) tissue of non-human origin, with or without other bioengineered or processed elements, with metabolically active elements, per square centimeter.

1. The product is intended to be used for the management of wounds including:
  • Treatment of neuropathic diabetic foot ulcers that have failed conservative measures of at least four weeks duration.
  • Treatment of partial and full-thickness skin venous insufficiency ulcers present for a minimum of four weeks duration and have failed conventional treatment for at least two weeks.
  • Skin substitute used in conjunction with standard wound care regiment.
2. This product is covered when the medical record clearly documents that the product is being used in an office or clinic based comprehensive, organized wound management program.

Q4106 Skin substitute, dermagraft, per square centimeter

Dermal (substitute) tissue of human, with or without other bioengineered or processed elements, with metabolically active elements, per square centimeter

1. This product is covered for the treatment of full-thickness diabetic foot ulcers of greater than six weeks duration, which extend through the dermis, but without tendon, muscle, joint capsule or bone exposure.

2. This product is covered when the medical record clearly documents that the product is being used in an office or clinic based comprehensive, organized wound management program.

Q4110 - Skin substitute, primatrix, per square centimeter

Primatrix is intended for the management of wounds including partial and full-thickness wounds, pressure ulcers, venous ulcers, diabetic ulcers, chronic ulcers, tunneled /undermined wounds, surgical wounds (donor sites / grafts, post-Moh's surgery, post-laser surgery, podiatric, wound dehiscence), trauma wounds (abrasions, lacerations, second-degree bums, and skin tears), draining wounds.

1. When this service is rendered in place of service office, both the application of the skin graft and the product used must be billed on the same claim.

2. These codes may not be billed with a modifier 58 (staged procedure).

See also Theraskin

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