Reimbursement Overview

As a skin substitute with advanced technology, PuraPly® Antimicrobial is reimbursed in the high bundle by the Centers for Medicare & Medicaid Services (CMS). PuraPly Antimicrobial and PuraPly® are eligible for reimbursement for all sites of care. Effective January 1, 2019, each product now has its own Q code:

  • Q4196: PuraPly Antimicrobial
  • Q4195: PuraPly

Pass-through status extended through September 30, 2020

Truly innovative
CMS extended pass-through status to a select group of medical products identified as “truly innovative” to foster innovation and broaden access for Medicare beneficiaries.

Product reimbursement + facility fee
Pass-through allows for potential additional product reimbursement on top of a facility fee for a limited amount of time.

Medicare patients in 2 sites of care
Applies to Medicare patients treated in hospital outpatient sites and ambulatory surgical centers.

Positive reimbursement across all sizes
As the only skin substitute with pass-through status, PuraPly Antimicrobial offers separate reimbursement across all sizes—to treat all wounds.

Lower prices
Prices will continue to be lower per cm2 than other competitive skin substitutes on the market today.

Benefit Verification and Prior Authorization Program

Once you have decided to use PuraPly or PuraPly Antimicrobial, our team of Reimbursement Support Center Specialists will work closely with you through our benefit verification and prior authorization program. If needed, they are also available to perform a claims analysis and assist with appeals.

If you have any questions about reimbursement for PuraPly or PuraPly Antimicrobial, you can send a written inquiry on our Reimbursement Inquiry Page or call 1-888-432-5232 (option #3) to talk with a reimbursement specialist.