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.
