Page 13 - Fluid Flow - Amnio Hensler 6_2020

December 5, 2019

To Whom It May Concern;

To ensure that our Providers and Facility partners are protected financially from the use of our products
while leveraging our new Q Codes, BioLab Sciences, Inc. has developed the following program:

• BioLab Sciences will invoice, per our established price points, for all products intended for
reimbursement through the Centers for Medicare and Medicaid (CMS) and commercial payers.

• If authorized, the Providers and Facilities should expect to receive 106% of the invoiced cost of
the products provided by BioLab Sciences by following the recommendations in our billing guide
and inclusion of information on HCFA Line 19.

• If the Provider and/or Facility receives an EOB that is less than the 106% of the invoiced cost of
the product(s), BioLab will ensure that the practice achieves at least a 10% profit by adjusting
the invoice. The Provider and/or Facility would need to share a copy of the EOB with BioLab in
order to be eligible for the adjustment.

• This program is effective for purchases through March 31, 2020 and may be extended.

• This program applies to the following Q-codes:

• Q4205 – Membrane Wrap™
• Q4206 – Fluid Flow™
• Q4226 – MyOwn Skin™

For any further questions or concerns regarding BioLabs’ products and the established Q Codes, please
contact Scott Swonger or Jaime Leija at 480-935-3744 or Jleija@biolabsciences.net/
Sswonger@biolabsciences.net

Respectfully,

Jaime Leija
Chief Commercialization Officer
BioLab Sciences