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Official Description

Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter
Short Descr Integra drt or omnigraft
Coverage Carrier Priced
Pricing Indicator(s) 51 – Drugs
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS O1E – Other drugs
TOS Code(s) 1 – Medical care
Added Date 1/1/2009
Status Code Excluded from Physician Fee Schedule by Regulation
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
CCS Clinical Classification 243 - DME and supplies
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
2017-01-01 Changed Description Changed
2011-01-01 Changed Description Changed
2009-01-01 Added -
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