NC Medicaid is updating the 1G-2 Skin Substitutes Policy with the following changes:
- Adding coverage for CPT codes (Effective June 1, 2021):
- Q4128 – Flex Hd, Allopatch Hd, Or Matrix Hd, Per Square Centimeter
- Q4151 - Amnioband Or Guardian, Per Square Centimeter
- Q4132 - Grafix Core And Grafixpl Core, Per Square Centimeter
- Q4133 - Grafix Prime, Grafixpl Prime, Stravix And Stravixpl, Per Square Centimeter
- Changing the unit limit for the product Apligraf (Q4101) from “88 units every 365 calendar days” to “176 units every 180 calendar days” (Effective June 1, 2021)
Contact
NCTracks Call Center: 800-688-6696