Sanoplast ECM Amniotic Membrane is a sterile single layer allograft
designed for optimal wound covering and protection during
the treatment of wounds.
Features & Properties
Provides a protective wound covering
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
Ordering Information I Q4314
PRODUCT NUMBER
SIZE
TOTAL UNITS (PER SQCM)
ORI-0202
2X2
4
0RI-0203
2X3
6
ORI-0404
4X4
16
ORI-0406
4X6
24
0RI-0408
4X8
32
ORI-1020
10X20
200
ORI-1520
15X20
300
Single Layer Sanoplast ECM is an amniotic membrane allograft derived from a prescreened mother with a planned
C-section delivery. Sanoplast Optic Single layer for use for a variety of inflammatory eye conditions. Sanoplast ECM
Amniotic Membrane Allograft 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.
Sanoplast ECM Amniotic Membrane Allograft 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 Single Layer Sanoplast
ECM 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
POS 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
Sanoplast EC is not included on the Medicare Part B
Average Sales Price (ASP) 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 poste d
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.
