Page 26 - HSP - MyOwnSkin Booklet 6_2020 Booklet RV2

MyOwn Skin™ CPT Coding Guide

MyOwn Skin™ is an autologous partial-thickness skin graft intended for homologous uses of skin tissues which may include the repair,
reconstruction, replacement, or supplementation of skin tissues and the integumentary system. Qualified medical providers may use
MyOwn Skin™ to treat patients who have suffered from an event, disease, process or acquired deficit that results in the functional loss
or void of skin tissues and the integumentary system in place of or in combination with split-thickness grafting, full-thickness grafting,
temporizing skin coverage and/or skin substitute products.

2019 CODING GUIDE: PROVIDER
Provider Coding Procedures Using MyOwn Skin™
The application of MyOwn Skin™ is performed in two phases: a harvest phase and an application phase. Performing these phases
may be covered by Current Procedural Terminology (CPT ) and Healthcare Common Procedure Coding System (HCPCS) codes.
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The provider should determine which codes should be used to request payment for each phase of the service.
CPT Code MCR Reimb MCR Reimb
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Process CPT Code Description
Detail LOW HIGH
MyOwn 106% of 106% of
Skin™ Q4226 MyOwn Skin, Includes Harvesting and Preparation Active Invoice** Invoice**
Product Procedures, per square centimeter 10/01/2019* $102.00/cm² $102.00/cm²
Code
Tissue cultured epidermal autograft, trunk, legs, arms:
15150 631.56 903.13
first 25 cm , or less
2
Combine to
+15151 Additional 1 cm to 75 cm 2 Reach 108.89 159.41
2
Aggregate
Each additional 100 cm , or each 1% BSA of infants and
2
+15152 134.16 196.75
MyOwn children
Skin™ Tissue cultured epidermal autograft, face scalp, eyelids,
Application 15155 mouth, neck, ear orbits, genitalia, hands, feet and/or 732.64 1034.05
2
multiple digits: first 25 cm or less Combine to
Reach
2
+15156 Additional 1 cm to 75 cm 2 146.79 215.42
Aggregate
Each additional 100 cm , or each 1% BSA of infants and
2
+15157 163.18 238.92
children

*Important Billing Instructions:
MyOwn Skin™ is not included on the Medicare Part B Average Sales Price (ASP) Pricing File published by the Centers for Medicare and
Medicaid Services (CMS) at this time. Per Chapter 17 of the Medicare Claims Processing Manual, MyOwn Skin™ is paid based on invoice
instead. Since the product cannot be ordered in sizes exactly to fit the graft, payers expect to pay for wastage.
• Box 19 on the CMS-1500 claim form allows the provider to include the invoice cost and product details (name and size).
• Payment based on invoice cost does not delay the electronic processing of claims.
• Providers should check with local payers to determine if an invoice is required to be submitted with the claim.
• Providers should check with local payers regarding appropriate use of modifiers.
• JC – Material used as a graft (enter cm² used for graft)
• JW – Wastage not used for graft (enter cm² trimmed and/or discarded)
• Use 2 lines of QCode to separate the material used from wastage.
• KX – Used on both Q code and CPT Code to indicate requirements of medical policy have been met.

BILLING UNITS

**Units Billed - Check units billed – Due to cross MyOwn Skin™ Size HCPCS Code Total cm² Billable Units
contamination issues, payers generally 5cm x 5cm Q4226 25cm² 25
reimburse for the entire sq cm piece, as it is 10cm x 10cm Q4226 100cm² 100
typically reasonable and necessary to discard a (2)- 10cm x 10cm Q4226 200cm² 200
portion of the product. It is recommended that (3)- 10cm x 10cm Q4226 300cm² 300
providers document wastage in the patient’s chart, and separate the used product and the discarded product into separate billing lines
using the appropriate modifiers. Minimum Order size is 25cm²
1. Current Procedural Terminology (CPT) is a registered trademark of the American Medical Association (AMA). Copyright 2019 AMA. All rights reserved.

© 2019 BioLab Sciences, Inc. All rights reserved. All trademarks used herein are trademarks of their respective owners.
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