Billing and Coding: Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities

Medicare coverage for CTP application to lower-extremity wounds requires medical necessity documented in the medical record and adherence to product-specific FDA labeling and guidelines. Coverage excludes more than ten CTP applications for a single wound within a 12-week episode, separately billed applications after 12 weeks, use of products on multiple patients, and uses non-compliant with product or policy criteria; thorough documentation (wound descriptions, procedure details, product lot, ABN where applicable) is required for claim adjudication.

"Application of a cellular and/or tissue-based product (CTP) to a documented lower-extremity wound is covered when the medical record supports medical necessity for the specific wound and treatment."

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