Skin Substitute Codes

If the CMS quarterly ASP file does not contain pricing for a skin substitute code that is within the Q41XX range, the claim must include the invoice price (amount physician paid, per invoice, for patient's specific item).

We will reimburse for the invoice price plus shipping but no additional fees (tax, handling fees, delivery fees, administrative fees).

ASP File Contains Code

  • Enter number of units in Item 24G of CMS-1500 claim form or Loop 2400/SV104 for EMC

ASP File Does Not Contain Code

  • Enter procedure code and total invoice price in Item 19 of CMS-1500 claim form or Loop 2400/SV101-7 for EMC
    • Price must be in currency format, include decimal. Examples
      • Invoice $130 - price claim at $1.30
      • Invoice 13000 - price claim at $130.00
      • Invoice $13000 - price claim at $130.00
      • Invoice $130.00 - price claim at $130.00

If the claim does not include the required information, the item will deny as unprocessable.

Providers must maintain an invoice copy within the patient's file and it must be made available to Noridian upon request.
 

Last Updated Aug 13, 2019