Coverage and Reimbursement Support

We partner with our customers to provide reimbursement support, including insurance verifications, payor trends, and claims and prior authorization support.

Need Help?

Contact us: 888.767.4849
reimbursement.wound@convatec.com

Our Reimbursement Team Can Support You With:

Benefit Verification

Our team of experienced verification specialists can help you verify patient-specific coverage for our products. Verification typically occurs within 24-48 hours.

Coding and Billing Questions

Our reimbursement team can help answer your coding and billing questions about our products.

Prior Authorization Support

Our reimbursement team can help you with prior authorization needs, including templates for letters of medical necessity and submission directions.

Overview of Key Steps

Step 1

Provider identifies patient

Step 2

Provider completes Patient Intake forms

Step 3

Our verification specialists conduct the insurance verification and notify Provider with the coverage details

Step 4

Provider contacts our Customer Service Department to place order for product

Get Started

Application Codes

CPT Code1 Medicare Non-Facility (Office) Rate2 CPT Description
15271 $152.08 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 $23.80 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
15273 $308.12 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 $81.98 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq. cm; each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)
15275 $156.70 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq. cm; first 25 sq. cm or less wound surface area
+15276 $32.07 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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)
15277 $341.84 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or equal to 100 sq. cm; first 100 sq. cm wound surface area, or 1% body area of infants and children
+15278 $94.55 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq. cm; each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)
  1. CPT is a registered trademark of the American Medical Association (AMA)
  2. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched, rates are national averages

Surgical Site Preparation Codes

Code Description
15002 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq. cm or 1% of body area of infants and children
+15003 Each additional 100 sq. cm, or part thereof, or each additional 1% of body area of infants and children
(List separately in addition to code for primary procedure)
15004 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq. cm or 1% of body area of infants and children
+15005 Each additional 100 sq. cm, or part thereof, or each additional 1% of body area of infants and children
(List separately in addition of code for primary procedure)
  1. Coverage for the surgical site preparation codes varies. Please review payor guidelines.
  2. Per coding guidelines, site preparation codes are billed once per wound.
  3. The application code is subject to the multiple procedure reduction rule if billed on the same day as the surgical site preparation code.

Need to know which MAC you are in?

The information in this document is not an affirmative instruction as to which codes and modifiers to use for a particular service, supply, procedure or treatment. It is the provider’s responsibility to determine and submit the appropriate codes and modifiers for any service, supply, procedure or treatment rendered. Actual codes and/or modifiers used are at the sole discretion of the treating physician and/or facility. Local payers and physician specialty societies should be contacted for specific coding guidelines. Convatec cannot guarantee medical benefit coverage or reimbursement with the codes listed in this document.

An emerging regenerative medicine company with a ground-breaking FDA-cleared technology platform engineered to address unmet needs in complex surgical wounds, hard-to-heal wounds, and burns, our company’s proprietary, patent pending technology provides innovative treatment solutions derived from naturally occurring ECM material and its related bioactive properties.


PRIVACY NOTICE

MKT-2023-0051-10E V01