Medicare Benefits Schedule - Note TN.8.301

Autologous skin cell suspension (ASCS) can be used on its own or in conjunction with autologous skin grafting for definitive burn wound closure (either immediate or delayed) where the total burn area being treated in the procedure (by one or multiple surgeons) is:

• at least 10% of total body surface for a patient aged less than 15 years; or
• at least 20% of total body surface for a patient aged 15 years or over; or
• for the whole of face.

For definitive burn wound closure using ASCS or ASCS in conjunction with autologous skin grafting, there may be procedures where the burn area being treated by a single surgeon is less than 10% of total body surface for a patient aged less than 15 years or less than 20% of total body surface for a patient aged 15 years or over. However, the total burn area being treated by multiple surgeons must be at least 10% of total body surface for a patient aged less than 15 years or at least 20% of total body surface for a patient aged 15 years or over.

For example, a single surgeon may be performing immediate definitive burn wound closure under item 46115 on 6% of total body surface for a patient aged less than 15 years. At the same time, another surgeon is performing immediate definitive burn wound closure under item 46115 on 6% of total body surface for the same patient. Because the total area being treated in this procedure is at least 10% of total body surface, ASCS or ASCS in conjunction with autologous skin grafting can be used.

Related Items: 46113 46114 46115 46116 46117 46118 46119 46120 46121 46122 46123 46124 46130 46131 46132 46133 46134 46135 46136

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Multiple Operation Rule

Excised burn wound closure, or closure of skin defect secondary to burns contracture release, to an area of less than 1% of total body surface, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision or contracture release; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface; or

(iii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound

(H)

(Anaes.) (Assist.)

Fee: $404.00 Benefit: 75% = $303.00

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, or closure of skin defect secondary to burns contracture release, to an area of at least 1% but less than 3% of total body surface, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision or contracture release; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface; or

(iii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound

(H)

(Anaes.) (Assist.)

Fee: $641.30 Benefit: 75% = $481.00

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure or closure of skin defect secondary to burns contracture release, to an area of at least 3% but less than 10% of total body surface, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision or contracture release; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface; or

(iii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound

(H)

(Anaes.) (Assist.)

Fee: $703.35 Benefit: 75% = $527.55

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure or closure of skin defect secondary to burns contracture release, to an area of at least 10% but less than 20% of total body surface, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision or contracture release; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) for a patient aged less than 15 years—autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iii) for a patient aged 15 years or over—autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure, if the total area being treated in the procedure is at least 20% of total body surface; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,073.10 Benefit: 75% = $804.85

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 20% but less than 30% of total body surface, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,443.15 Benefit: 75% = $1,082.40

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 30% but less than 40% of total body surface, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,813.90 Benefit: 75% = $1,360.45

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 40% but less than 50% of total body surface, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,184.00 Benefit: 75% = $1,638.00

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 50% but less than 60% of total body surface, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,553.45 Benefit: 75% = $1,915.10

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 60% but less than 70% of total body surface, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,923.60 Benefit: 75% = $2,192.70

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 70% but less than 80% of total body surface, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $3,331.00 Benefit: 75% = $2,498.25

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 80% of total body surface, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $3,730.50 Benefit: 75% = $2,797.90

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure of whole of face, if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,059.45 Benefit: 75% = $1,544.60

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, to an area involving less than 1% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface

(H)

(Anaes.) (Assist.)

Fee: $404.00 Benefit: 75% = $303.00

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, to an area involving at least 1% but less than 3% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface

(H)

(Anaes.) (Assist.)

Fee: $641.30 Benefit: 75% = $481.00

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, to an area involving at least 3% but less than 10% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface

(H)

(Anaes.) (Assist.)

Fee: $703.35 Benefit: 75% = $527.55

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, to an area involving at least 10% but less than 20% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) for a patient aged less than 15 years—autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting; or
(iii) for a patient aged 15 years or over—autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is at least 20% of total body surface;

(excluding aftercare) (H)

(Anaes.) (Assist.)

Fee: $1,073.10 Benefit: 75% = $804.85

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, to an area involving at least 20% but less than 30% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting;

(excluding aftercare) (H)

(Anaes.) (Assist.)

Fee: $2,374.90 Benefit: 75% = $1,781.20

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, to an area involving at least 30% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting;

(excluding aftercare) (H)

(Anaes.) (Assist.)

Fee: $3,730.50 Benefit: 75% = $2,797.90

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, of whole face, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting;

(excluding aftercare) (H)

(Anaes.) (Assist.)

Fee: $2,059.45 Benefit: 75% = $1,544.60

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)