FLOWERAMNIOPATCH™

REIMBURSEMENT QUICK REFERENCE GUIDEHOPD (Wound Care Center)

FLOWERAMNIOPATCHAmniotic Membrane Allograft

FlowerAmnioPatch is a dehydrated amniotic membrane allograft intended

for homologous use to supplement a recipient's tissue. It provides an

adhesion barrier for adjacent soft tissues and is an ideal material for covering

wounds. It is available in various sizes for improved handling, delivery, and

optimal coverage. The strength of the allograft allows for suturing in place

and eliminates bulk at the wound site.

Key benefits of FlowerAmnioPatch:• Extracellular Matrix Molecules

• Hyaluronic Acid

• Fibronectin

• Laminin

• Prostaglandins

Item No. Description Size

FBP 212 FlowerAmnioPatch 2x2 cm

FBP 213 FlowerAmnioPatch 2x3 cm

FBP 214 FlowerAmnioPatch 2x4 cm

FBP 414 FlowerAmnioPatch 4x4 cm

FBP 416 FlowerAmnioPatch 4x6 cm

Item No. Description Size

FBP 016 FlowerAmnioPatch 16mm Disc

Ordering Information

CPT APC Assignment

15271/15275/15277

HCPCS Code HCPCS Code Description Low/High Cost Skin Substitute

Q4178 FlowerAmnioPatch, per cm2 High

FLOWERAMNIO REIMBURSEMENT OVERVIEWHPCPS Coding Pathway Options

Wound Care Center (HOPD) Procedure• Determine if patient meets requirements for advanced wound therapy

• Order and receive selected product from Flower Orthopedics

• Treat patient in the Wound Care Center (HOPD) with FlowerAmnioPatch

• Physician submits appropriate CPT code to Medicare

• Wound Care Center submits appropriate CPT/APC code to Medicare

15273

*1-10 Data on file with Flower Orthopedics.© 2019 Flower Orthopedics. All rights reserved. FlowerAmnioPatch is a trademark of Flower Orthopedics. Please refer to package insert for descrip-tion, indications, contraindications, warnings, precautions, and other important information.

QUESTIONS?800-901-6264reimbursement@flowerortho.com

FLOWER ORTHOPEDICS CORPORATION • 100 WITMER ROAD, SUITE 280 • HORSHAM, PA 19044

T: 877.778.8587 • F: 215.394.8904 • WWW.FLOWERORTHO.COM

APC 5054 Level 4 Skin Procedure

APC 5055 Level 5 Skin Procedure

Please see the Flower Orthopedics 2019 Comprehensive Reimbursement Resource Guide for additional information.

Disclaimer: This information is for educational/informational purposes only and should not be construed as authoritative. The information presented here is current as of May 2019 and is based upon publicly available source information. Codes and values are subject to frequent change without notice. The entity billing Medicare and/or third-party payors is solely responsible for the accuracy of the codes assigned to the services or items in the medical record. When making coding decisions, we encourage you to seek input from the AMA, relevant medical societies, CMS, your local Medicare Administrative Contractor and other health plans to which you submit claims. Items and services that are billed to payors must be medically necessary and supported by appropriate documentation. It is important to remember that while a code may exist describing certain procedures and/or technologies, it does not guarantee payment by payors.

FOC 1029 Rev A