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American Medical Association (AMA)

CPT Changes 2007

The Skin Replacement Surgery and Skin Substitute introductory-language has been editorially revised by removing the phrase "without surgical fixation of the skin substitute/graft" from the last paragraph. The language continues to indicate that fixation is required. The word surgical has been removed from the text. However, because some types of skin substitutes or grafts do not require surgical fixation, the revised language gives the surgeon the ability to choose the most appropriate type of fixation.1

For Questions regarding reimbursement related to Apligraf® please call the Reimbursement Support Center (1-888-Heal-2-DAY), Option 3.

Click the state on the map to find state specific coding and coverage guidelines where it is available. Select Medicare LCD Summary Part A or Medicare LCD Summary Part B.

Alabama

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Without a formal policy

 

 

Alaska

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Noridian Administrative Services

 

 

Arizona

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Noridian		Noridian Administrative Services

 

 

Arkansas

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Pinnacle		Pinnacle

 

 

California

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Palmetto GBA Medicare MAC Part A Policy		Palmetto GBA Medicare MAC Part B Policy

 

 

Colorado

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
TrailBlazer		Trailblazer (MAC J4 B) - 3/21/08

 

 

Connecticut

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		First Coast Service

 

 

Delaware

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		Highmark Medicare Part B Policy

 

 

District of Columbia

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Highmark Medicare Part A Policy		Highmark Medicare Part B Policy

 

 

Florida

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
First Coast Service		First Coast Service

 

 

Georgia

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Without a formal policy

 

 

Hawaii

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Palmetto GBA Medicare MAC Part A Policy		Palmetto GBA Medicare MAC Part B Policy

 

 

Idaho

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Cigna

 

 

Illinois

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		Wisconsin Physicians Service

 

 

Indiana

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		National Government Services

 

 

Iowa

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Wisconsin Physicians Services (MAC B)

 

 

Kansas

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Wisconsin Physicians Services (MAC B)

 

 

Kentucky

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		National Government Services

 

 

Louisiana

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Pinnacle

 

 

Maine

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		Without a formal policy

 

 

Maryland

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Highmark Medicare Part A Policy		Highmark Medicare Part B Policy

 

 

Massachusetts

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		Without a formal policy

 

 

Michigan

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		Wisconsin Physicians Service

 

 

Minnesota

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Noridian		Wisconsin Physicians Service

 

 

Mississippi

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Without a formal policy

 

 

Missouri

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Pinnacle (Eastern)
Without a formal policy		Wisconsin Physicians Services (MAC B) (Western)

 

 

Montana

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Noridian		Noridian Administrative Services

 

 

Nebraska

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Wisconsin Physicians Services (MAC B)

 

 

Nevada

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Palmetto GBA Medicare MAC Part A Policy		Palmetto GBA Medicare MAC Part B Policy

 

 

New Hampshire

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		Without a formal policy

 

 

New Jersey

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Highmark Medicare Part A Policy		National Government Services

 

 

New Mexico

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
TrailBlazer		Trailblazer (MAC J4 B)

 

 

New York

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		National Government Services

 

 

North Carolina

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Cigna

 

 

North Dakota

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Noridian		Noridian Administrative Services

 

 

Ohio

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		Palmetto GBA

 

 

Oklahoma

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Trailblazer (MAC J4 A)		Trailblazer (MAC J4 B)

 

 

Oregon

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Noridian Administrative Services

 

 

Pennsylvania

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Highmark Medicare Part A Policy		Without a formal policy

 

 

Puerto Rico

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Without a formal policy

 

 

Rhode Island

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Pinnacle		Pinnacle

 

 

South Carolina

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Palmetto GBA

 

 

South Dakota

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Noridian		Noridian Administrative Services

 

 

Tennessee

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
BCBS of Tennessee		Cigna

 

 

Texas

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
TrailBlazer		TrailBlazer

 

 

Utah

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Noridian		Noridian Administrative Services

 

 

Vermont

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		Without a formal policy

 

 

Virginia

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		TrailBlazer

 

 

Virgin Islands

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Without a formal policy

 

 

Washington

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Without a formal policy		Noridian Administrative Services

 

 

West Virginia

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		Palmetto GBA

 

 

Wisconsin

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
National Government Services FI		Wisconsin Physicians Service

 

 

Wyoming

 

Medicare Part A LCD Summaries		Medicare Part B LCD Summaries
Noridian		Noridian Administrative Services

 

1American Medical Association, CPT Changes 2007-An Insider’s View, pg. 27

Disclaimer: The information provided on this website is informational only. This is not a guarantee of Reimbursement Rates, nor is it intended to make recommendations regarding clinical practices. Information on this website is subject to change with out notice due to changes in reimbursement laws, regulations, rules and policies. The ultimate responsibility for correct coding lies with the provider of services. Please contact the appropriate payer for their interpretation of the appropriate code to use for the procedure.

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