SUFRGFRAFT FT

Full-Thickness Graft

SurGraft FT is a sterile full thickness graft designed for optimal wound covering and protection during the treatment of wounds.

Features & Properties

Provides a reliable protective wound covering backed by decades
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

SurGraft FT Ordering Information I Q4268

PRODUCT NUMBER

SIZE

TOTAL UNITS (PER SQCM)

SFT-020202

2X2

4 SFT-020203

2X3

6 SFT-020404

4X4

16 SFT-020406

4X6

24 SFT-020408

4X8

32 SFT-021220

12X20

240 SurGraft FT full thickness graft is an allograft derived from a prescreened mother with a planned delivery.

SurGraft FT 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.

SurGraft FT 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 SurGRaft FT full thickness graft and associated procedures varies by Medicare and private payers. Coverage policies, prior authorizations, contact 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 services above the level of custodial care to other than individuals with intellectual disabilities

Reimbursement inquiries:

reimbursement@ legacymedicalconsultants.com

Place of Service (POS) Codes

SurGraft FT full thickness graft 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 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.

CPr @ 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.

SUFRGFRAFT FT

Full-Thickness Graft

SurGraft FT is a sterile full thickness graft designed for optimal wound covering and protection during the treatment of wounds.

Features & Properties

SurGraft FT Ordering Information I Q4268

PRODUCT NUMBER

SIZE

TOTAL UNITS (PER SQCM)

SFT-020202

2X2

4

SFT-020203

2X3

6

SFT-020404

4X4

16

SFT-020406

4X6

24

SFT-020408

4X8

32

SFT-021220

12X20

240

SurGraft FT full thickness graft is an allograft derived from a prescreened mother with a planned delivery.

SurGraft FT 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.

SurGraft FT 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 SurGRaft FT full thickness graft and associated procedures varies by Medicare and private payers. Coverage policies, prior authorizations, contact terms, billing edits, and site-of-service influence reimbursement

Place of Service (POS) Codes

PRODUCT NUMBER

PLACE OF SERVICE LOCATION

PLACE OF SERVICE DESCRIPTION

11

Office

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 services above the level of custodial care to other than individuals with intellectual disabilities

Reimbursement inquiries:

reimbursement@ legacymedicalconsultants.com

Place of Service (POS) Codes

SurGraft FT full thickness graft 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) .

CPr @ Coding

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