NEW GammaGraft Coding!

 

 

Click Here for More Reimbursement Information

 

 

Promethean LifeSciences, Inc. is pleased to announce that GammaGraft has received a

Preliminary Decision by the Centers for Medicare and Medicaid Services (CMS) to

receive a new J code unique for GammaGraft.

 

CMS will finalize the J code decision in November, with the new J code taking effect January 1, 2009. 

 

The recommended code for use with GammaGraft until the new code issues is J3590.  The J3590 code is for

Unclassified Biologics, or biologics awaiting their own code.  

 

Here is the recommended billing in various settings: 

 

Billing J3590 in the office setting: The Physician should bill the standard CPT codes for application of allograft skin.  The office may bill for GammaGraft using the Unclassified Biologics code J3590.  The office should be reimbursed in the usual manner for the CPT codes, and will receive 80% of the office’s billing rate for the product. 

 

Billing in the hospital:     Billing is under the Diagnostic Related Group system, where the hospital is paid a single fee based on the diagnosis code.  The hospital does not bill separately for materials and the GammaGraft is bundled into the total costs. 

 

Billing in an Outpatient setting:  The Unclassified Biologics code J3590 does not have an associated payment rate in the Outpatient Setting.  The reimbursement staff should contact the Medical Director of the Payer group to discuss the method of reimbursement recommended.  Human skin allograft is considered the Gold Standard for wound care, however, there is no existing J code for human skin.  Feel free to contact Promethean LifeSciences, Inc. for assistance documenting GammaGraft usage and utility and in requesting reimbursement clarification. 

 

Disclaimer:  Information on reimbursement in the U.S. is provided as a service. Due to the rapidly changing nature of the law and our reliance on information provided by outside sources, the information provided herein does not constitute a guarantee or warranty by Promethean LifeSciences, Inc. that reimbursement will be received. This information is provided “AS IS” and without any other warranty or guarantee, expressed or implied, as to completeness or accuracy, or otherwise.  Physicians and other providers must confirm or clarify coding and coverage from their respective payers, as each payer may have differing Local Coverage Determinations (LCDs). Physicians and providers are responsible for accurate documentation of patient conditions and for reporting of procedures and products in accordance with particular payer requirements.