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Official Description

Mirragen advanced wound matrix, per square centimeter
Short Descr Mirragen adv wnd mat per sq
Coverage Carrier Priced
Pricing Indicator(s) 13 – Physician Fee Schedule - Price established by carriers (e.G., not otherwise classified, individual determination, carrier discretion)
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS P5A – Ambulatory procedures - skin
TOS Code(s) 1 – Medical care
Added Date 1/1/2022
Status Code Carriers Price the Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 9 - Not Applicable
Multiple Procedures (51) 9 - Concept does not apply.
Bilateral Surgery (50) 9 - Concept does not apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 9 - Concept does not apply.
Co-Surgeons (62) 9 - Concept does not apply.
Team Surgery (66) 9 - Concept does not apply.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Items and Services Packaged into APC Rates
ASC Payment Indicator Packaged service/item; no separate payment made.
MUE Not applicable/unspecified.
MUE Not applicable/unspecified.
OTS Orthotic No
JZ Zero drug amount discarded/not administered to any patient
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
JW Drug amount discarded/not administered to any patient
A1 Dressing for one wound
JC Skin substitute used as a graft
LT Left side (used to identify procedures performed on the left side of the body)
Date
Action
Notes
2022-01-01 Added Code added.
Code
Description
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