…With a Question About the per CM Sq. Price Variations for Products

Check out the entire series here.

I am in the Novitas Medicare Jurisdiction and I keep an eye on their Medicare Newsletter. Here are the instructions for submitting claims for CTPs/skin subs when the claim in a doctor’s office exceeds $99,999.99. The example they give is “The patient received 288 sq cm of Q4262 for a total billed amount of $388,800.00. The unit of service is based on 1 sq. cm…”  By my calculation, that’s $1,350 per cm2.

We’ve already discussed the fact that you can’t treat large wounds in the hospital based outpatient department (HOPD) since the total amount the hospital can get for the product plus the application is around $1,500 – no matter how big the wound is and no matter how many centimeters of product you need to cover it. Therefore, it certainly isn’t possible to treat a 288 sq. cm wound in the HOPD. So, I get it that these unfortunate patients have to be treated in the doctor’s office. I am glad there is somewhere for them to go. (I am going to asssume that treatment with a CTP was the right thing to do clinically, that this particular CTP is so much better than less expensive ones that it was the right choice, and that the selection was not made on the basis of “the spread,” meaning, how much profit the doctor was going to make on the product itself.)

I am trying to get my head around the fact that the product in this example was over $1000 per cm2 (and some are much more expensive than that). This is an amniotic product, made from raw materials supplied by a woman who just had a baby (and who can’t get compensated for it), and the product can only be “minimally manipulated” afterwards. That makes me curious what the per cm2 variation is for amniotic products. Would anyone provide me with that information – the variation in price per cm2 for products in that category? I’d also like to know what causes the wide variations in cost. There must be a good reason since it’s our tax dollars that are paying for it.