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Billing and Coding Guidelines - CMS

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Billing and Coding Guidelines : GSURG-052 Application of Bioengineered Skin Substitutes LCD Database ID Number L30135. Effective Date 08/16/2009. Contractor Name Wisconsin Physicians Service Insurance Corporation Contractor Number 00951, 00952, 00953, 00954. 05101, 05201, 05301, 05401, 05102, 05202, 05392, 05302, 05402. 52280. CMS Regulations Title XVIII of the Social Security Act section 1862 (a)(1)(A). This section allows coverage and payment of those services that are considered to be medically reasonable and necessary.

Documentation Requirements 1. The medical record must clearly show that the criteria listed in LCD GSURG-052 under “Indications and Limitation of Coverage and/or Medical Necessity” have been met. 2. The medical record must clearly document that conservative pre-treatment wound management has been tried and failed to induce healing. 3.

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