2019 National Medicare Reimbursement Rate Summary* for Integra® Flowable Wound Matrix – Hospital

Outpatient Department, Ambulatory Surgical Center and Physician Fee Schedule Rates

Integra LifeSciences Corporation compiles this summary of Medicare payment rates to provide information on payments for items and services
related to its products. Because Medicare rates are the only publicly posted rates and many other payers use the Medicare payment levels to set
their own rates, the figures below are provided as a frame of reference for customers. The identification of payment rates is not a guarantee of
coverage by Medicare or other payers, as there are non-coverage policies related to Integra® Flowable Wound Matrix. Each Provider is responsible
for verifying coverage with the patient’s insurance carrier, including the applicability of any non-coverage decision that may exist for Integra® Flowable
Wound Matrix. Moreover, the identification of codes in this document should not be construed as providing clinical advice, dictating reimbursement
policy, or substituting the judgment of a practitioner. It is always the Provider’s responsibility to determine and submit appropriate codes,
charges, and modifiers for services that are rendered.

Debridement Codes - Hospital Outpatient Department/Ambulatory Surgical Center Setting

CPT Code APC Status Hospital Status Ambulatory

Code Description Indicator Outpatient Indicator Surgical
OPPS ASC Center
11042 Debridement, subcutaneous tissue (includes epidermis and 5052 T $314.08 A2 $161.71
dermis, if performed); first 20 sq cm or less
+11045 each additional 20 sq cm, or part thereof (List separately N/A N $0 N1 $0
in addition to code for primary procedure)
(use 11045 in conjunction with 11042)
11043 Debridement, muscle and/or fascia (includes epidermis, 5053 T $482.89 A2 $248.63
dermis, and subcutaneous tissue; if performed); first 20 sq
cm or less
+11046 each additional 20 sq cm, or part thereof (List separately N/A N $0 N1 $0
in addition to code for primary procedure)
(use 11046 in conjunction with 11043)
11044 Debridement, bone (includes epidermis, dermis, 5072 J1 $1375.50 A2 $546.90
subcutaneous tissue, muscle and/or fascia, if performed);
first 20 sq cm or less
+11047 each additional 20 sq cm, or part thereof (List separately N/A N $0 N1 $0
in addition to code for primary procedure)
(use 11047 in conjunction with 11044)

+ = Add-on code
Active Wound Care Management - Hospital Outpatient Department/Ambulatory Surgical Center Setting

CPT Code APC Status Hospital Status Ambulatory

Code Description Indicator Outpatient Indicator Surgical
OPPS ASC Center
97597 Debridement (eg, high pressure waterjet with /without 5051 T $176.45 N/A N/A
suction, sharp selective debridement with scissors, scalpel
and forceps), open wound, (eg, fibrin, devitalized epidermis
and/or dermis, exudates, debris, biofilm), including topical
application(s), wound assessment, use of a whirlpool, when
performed and instruction(s) for ongoing care, per session,
total wound(s) surface area; first 20 sq cm or less
+97598 each additional 20 sq cm, or part thereof (List separately N/A N $0 N/A N/A
in addition to code for primary procedure)
(use 97598 in conjunction with 97597)
97602 Removal of devitalized tissue from wound(s), non-selective 5051 Q1 $176.45 N/A N/A
debridement, without anesthesia (eg, wet-to-moist
dressings, enzymatic, abrasion), including topical
application(s), wound assessment, and instruction(s) for
ongoing care, per session

OPPS Status Indicator - T = Significant Procedure, Multiple Reduction Applies

N = Items and Services Packaged into APC Rates
J1 = Paid under OPPS; all covered Part B services on the claim are packaged with the primary "J1" service for the
claim, except services with OPPS SI=F, G, H, L and U; ambulance services; diagnostic and screening
mammography; all preventive services; and certain Part B inpatient services
Q1 = Paid under OPPS; Addendum B displays APC assignments when services are separately payable.
(1) Packaged APC payment if billed on same claim as a HCPCS code assigned to status indicator “S,” “T,” or “V.”
(2) Composite APC payment if billed with specific combinations of services based on OPPS composite-specific payment criteria.
Payment is packaged into a single payment for specific combinations of services

ASC Status Indicator – A2 = Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
N1 = Packaged service/item; no separate payment made

2019 National Medicare Reimbursement Rate – HCPCS Summary for Integra® Flowable Wound Matrix –
Hospital Outpatient Department/Ambulatory Surgical Center Setting

Product HCPCS Description CY 2019

Code Status
Indicator
Integra® Q4114 Integra® Flowable Wound Matrix, injectable, 1cc N – OPPS
Flowable N1 - ASC
Wound
Matrix
Status Indicator – N/N1 = Packaged with procedure
Debridement Codes - Physician Fee Schedule – Facility or Non-Facility Setting

CPT Code RVU Physician Physician

Code Description Facility Non-Facility

11042 Debridement, subcutaneous tissue (includes epidermis and 1.01 $63.43 $124.70
dermis, if performed); first 20 sq cm or less
+11045 each additional 20 sq cm, or part thereof (List separately 0.50 $27.39 $42.53
in addition to code for primary procedure)
(use 11045 in conjunction with 11042)
11043 Debridement, muscle and/or fascia (includes epidermis, 2.70 $160.37 $236.78
dermis, and subcutaneous tissue; if performed); first 20 sq
cm or less
+11046 each additional 20 sq cm, or part thereof (List separately 1.03 $58.02 $75.32
in addition to code for primary procedure)
(use 11046 in conjunction with 11043)
11044 Debridement, bone (includes epidermis, dermis, 4.10 $237.14 $321.83
subcutaneous tissue, muscle and/or fascia, if performed);
first 20 sq cm or less
+11047 each additional 20 sq cm, or part thereof (List separately 1.80 $102.71 $127.22
in addition to code for primary procedure)
(use 11047 in conjunction with 11044)

Active Wound Care Management - Physician Fee Schedule – Facility or Non-Facility Setting

CPT Code RVU Physician Physician

Code Description Facility Non-Facility

97597 Debridement (eg, high pressure waterjet with /without 0.51 $24.51 $90.82
suction, sharp selective debridement with scissors,
scalpel and forceps), open wound, (eg, fibrin, devitalized
epidermis and/or dermis, exudates, debris, biofilm),
including topical application(s), wound assessment, use
of a whirlpool, when performed and instruction(s) for
ongoing care, per session, total wound(s) surface area;
first 20 sq cm or less
+97598 each additional 20 sq cm, or part thereof (List 0.24 $11.53 $28.47
separately in addition to code for primary procedure)
(use 97598 in conjunction with 97597)
97602 Removal of devitalized tissue from wound(s), non- 0.00 N/A N/A
selective debridement, without anesthesia (eg, wet-to-
moist dressings, enzymatic, abrasion), including topical
application(s), wound assessment, and instruction(s) for
ongoing care, per session
2019 National Medicare Reimbursement Rate – HCPCS Summary for Integra® Flowable Wound Matrix –
Physician Fee Schedule – Facility or Non-Facility Setting

Product HCPCS Description Physician

Code Office
Rate
Integra® Q4114 Integra® Flowable Wound Matrix, injectable, 1cc At MAC**/
Flowable Payer
Wound Discretion
Matrix
**MAC – Medicare Administrative Contractor

For assistance with coding and reimbursement, please contact our Integra
Reimbursement Hotline at 1-877-444-1122, option 3, option 1, Monday to Friday,
8 am to 6 pm, or via email at smartreimbursement@integralife.com

*The information provided is an abbreviated summary of coding and reimbursement rates associated with Integra® Flowable Wound Matrix.
Rates may represent national average payments that are subject to adjustment (e.g., for locality). The information provided is only specific
to coding and reimbursement rates for the hospital outpatient department, ambulatory surgical center setting and physician fee schedule.
While Integra LifeSciences Corporation intends to use reasonable efforts to provide accurate coding information, this information should not be
construed as providing clinical advice, dictating reimbursement policy, or substituting for the judgment of a practitioner. It is always the Provider’s
responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Integra LifeSciences
Corporation assumes no responsibilities or liabilities for the timeliness, accuracy, and completeness of the information contained herein. Since
reimbursement laws, regulations, and payor policies change frequently, it is recommended that providers consult with their payors, coding specialists,
and/or legal counsel regarding coverage, coding and payment issues

Reference: CPT® Code Book 2019. Current Procedural Terminology (CPT) copyright 2018 American Medical Association (AMA). All rights reserved.
CPT is a registered trademark of the American Medical Association. Fee Schedules, relative value units, conversion factors and/or related
components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly
practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Integra and the Integra logo are registered trademarks of Integra LifeSciences Corporation in the United States and/or other countries. ©2019
Integra LifeSciences Corporation. All rights reserved.

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