Dual Layer lmpax: Membrane is a sterile allograft designed for optimal
wound covering and protection during the treatment of wounds.
Features & Properties
Provides a reliable protective wound covering backed by decades of science
Dehydrated extracellular matrix acts as a scaffold supporting the native tissue
Adheres easily to wounds including those with irregular surfaces
5-year shelf life at ambient temperature storage
Dual Layer lmpax Membrane Ordering information I Q4262
PRODUCT NUMBER
SIZE
TOTAL UNITS (PER SQCM)
IMP-0202
2X2
4
IMP-0203
2X3
6
IMP-0404
4X4
16
IMP-0406
4X6
24
IMP-0408
4X8
32
IMP-1020
10X20
200
IMP-1520
1SX20
300
Dual Layer lmpax Membrane is an amniotic membrane allograft derived from a prescreened mother with a
planned delivery. Dual Layer lmpax Membrane is manufactured in compliance with FDA regulations and AATB
guidance. The membrane is minimally processed to preserve the native structure of the tissue, dehydrated,
and terminally sterilized. Dual Layer lmpax Membrane is confirmed by the FDA Tissue Reference Group to
meet the criteria for regulation solely under Section 361 of the PHS Act. as defined in 21 CFR Part 1271.
General Information
Reimbursement and coverage eligibility for the use of
Dual layer lmpax Membrane and associated procedures varies
by Medicare and private payers. Coverage policies, prior authorizations,
contract terms, billing edits, and site-of-service influence reimbursement.
Place of Service (POS) Codes
PO S codes are 2-digit numbers included on health care
professional claims to indicate the setting in which a
service was provided. The Centers for Medicare and
Medicaid Services (CMS) maintain POS codes used
throughout the healthcare industry . These codes
should be used on professional claims to specify the
entity where service(s) were rendered. Check with
individual payers for reimbursement policies regarding
these codes.
PRODUCT NUMBER
PLACE OF
SERVICE
LOCATION
PLACE OF SERVICE
DESCRIPTION
11
Office
Location other than a hospital,
skilled nursing facility (SNF),
military treatment facility,
community health center, State
or Local public health clinic, or
intermediate care facility (ICF),
where the health professional
routinely provides health
examinations, diagnosis, and
treatment of illness or injury on
an ambulatory basis.
12
Home
Location, other than a hospital
or other facility, where the
patient receives care in a
private residence
32
Nursing
Facility
A facility which primarily provides
to residents skilled nursing care
and related services for the
rehabilitation of injured, disabled,
or sick persons, or, on a regular
basis, health-related care serv ices
above the level of custodial care
to other than individuals with
intellectual disabilities
Reimbursement inquiries:
reimbursement@ legacymedicalconsultants.com
Place of Service (POS) Codes
Dual Layer lmpax: Membrane is included on the
Medicare Part B Average Sales Price (AS P) Drug Pricing
File published quarterly by the Centers for Medicare
and Medicaid Services (CMS)
Average Sales Price information is published quarterly by the Centers for Medicare and Medicaid Services (CMS) in the ASP Medicare Part B Drug Pricing File or Not Otherwise Classified (NOC) Pricing File. Providers are encouraged to review the ASP Pricing files posted quarterly by CMS and listed by HCPCS on CMS.gov for updates. Payment allowance limits that are not included in the ASP Medicare Part B Drug Pricing file or Not Otherwise Classified (NOC) Pricing File, are based on the published Wholesale Acquisition Cost WAC) or invoice pricing. In determining the payment limit based on WAC, the contractors follow the methodology specified in Publication. 100-04, Chapter 17, Drugs and Biologicals, for calculating the Average Wholesale Price (AWP), but substitute WAC for AWP. Providers are encouraged to check with their local MACs for information on established rates. Providers are also encouraged to check with payers to determine if an invoice is required to be submitted with the claim and/or in Box 19 of the CMS-1500 claim form.
CPT® Coding
The Current Procedural Terminology (CPT) code set
describes medical, surgical, and diagnostic services and
is designed to communicate uniform information about
medical services and procedures among physicians,
coders, patients, accreditation organizations, and payers
for administrative, financial, and analytical purposes.
Physicians should report all surgical and medical services
performed, and are responsible for determining which
CPT® code(s) are appropriate.