Epicel graft

Reimbursement support

Due to the complexity of some burn cases, coding for Epicel treatment can often require extra attention. The reimbursement guides provided below and the support hotline at 1-800-CEA-SKIN (1-800-232-7546) can help ensure Epicel is both documented and coded correctly.

Epicel Total Care

Our reimbursement support hotline is staffed with experts to answer questions about the reimbursement of Epicel and the CEA procedure

Call Now

1-800-CEA-SKIN
(1-800-232-7546)

Reimbursement Support

We'll help your clinical and finance teams provide guidance on reimbursement

CEA Coding Assistance

We can share coding groups to help you understand which procedures associated with Epicel are eligible for reimbursement

Customer
Service

We are available to answer any questions you have in order to help you smoothly navigate Epicel coverage

Reimbursement and coding guidelines

Epicel CPT Coding Guide

Epicel ICD-10 Coding Guide

Navigating the steps of Epicel reimbursement

At time of Epicel biopsy

Enter Biopsy Codes

Enter codes for all procedures associated with Epicel biopsy into the patient chart

Pre-surgery

Epicel Ordering

Ensure medical records department recognizes the Epicel order and uses the appropriate ICD and CPT procedure codes

Epicel delivery

Identify Procedures

Identify all procedures associated with Epicel in the treatment plan utilizing Epicel ICD and CPT procedure codes

Post-surgery

Enter Surgery Codes

Monitor reimbursement of ICD-10 and product codes by comparing actual payments to agreed-upon terms

Please note: This is not intended to be a directive, nor is it a suggestion about the likelihood of obtaining reimbursement. This list is not all inclusive, and physician and staff may deem other codes more appropriate. Providers should select coding options that most accurately reflect a patient's condition, the provider's system guidelines, payor requirements and services rendered.

Call the Epicel reimbursement support hotline to speak with our reimbursement experts

Call Now

1-800-CEA-SKIN
(1-800-232-7546)

Epicel is widely reimbursed and included on a majority of national insurance plans.
Click here to learn more about Epicel reimbursement

Humanitarian Device

Epicel (cultured epidermal autografts) is authorized for use in adults and pediatric patients who have deep dermal or full thickness burns comprising a total body surface area greater than or equal to 30%. It may be used in conjunction with split-thickness autografts, or alone in patients for whom split-thickness autografts may not be an option due to the severity and extent of their burns. The effectiveness of the device for this use has not been demonstrated.

Important Safety Information

Epicel is contraindicated in patients with a history of anaphylaxis following exposure to vancomycin, amikacin, and amphotericin, as trace quantities of these anti-infective agents may remain in the Epicel autograft. Epicel should not be used in patients with known sensitivities to materials of bovine or murine origin. It is contraindicated for use on clinically infected wounds.

Because Epicel is manufactured with and contains residual amounts of murine cells, FDA considers it a xenotransplantation product. Therefore, recipients should not donate whole blood, blood components, source plasma, source leukocytes, tissues, breast milk, ova, sperm, or other body parts for use in humans because there is a potential risk of carrying an infection that is transmitted from mouse cells to humans.

Squamous cell carcinoma (SCC) has been reported in patients with burn injury after being grafted with Epicel. Although SCC is a known complication of burn scars, the role of Epicel in the causation of SCC cannot be excluded.

The Epicel product is intended solely for autologous use. Patients undergoing the surgical procedure associated with Epicel are not routinely tested for transmissible infectious diseases. Discontinue use if the patient shows evidence of allergic reaction.

If clinical signs of infection are present of develop, do not apply Epicel until the infection is adequately treated.

The effectiveness of Epicel has not been proven in clinical studies.

The long-term safety of Epicel is unknown. Over the past 27 years, the mortality from all causes was 13% before hospital discharge.

Men and women who intend to have children should be advised that the effects, if any, of Epicel on fetal development have not been assessed. In addition, the safety of Epicel has not been studied in pregnant and nursing women.

Patient information supplied by attending burn teams from 1989 to 1996 reported the adverse events of highest incidence as: death (13%), infection (13.8%), graft tear (7.8%) or graft blister (4.2%) and drainage (3.3%). Some of these events may have been due to the underlying burn injury and not the device itself.

From June 1998 through September, 2015 adverse events received by Genzyme Biosurgery (predecessor in interest to Vericel) and Vericel Corporation were similar to the previously identified adverse events. Events that were reported in ≥ 1% of patients included multi-organ failure (6.6%), sepsis (5.2%) infection (4%) and skin graft failure/graft complication (2.7%). The relationship of these events to Epicel has not been established.

Please see Patient Information and Directions for Use for more information

References
  1. W. Hickerson, MD. FACS,T. McKeen, et al. Cultured Epidermal Autografts (CEA) for Coverage of Large Burn Wounds in Pediatric and Adult Patients, 1989-2015. 2017 Annual Meeting, American Burn Association March 23, 2017
  2. American Burn Association National Burn Repository 2016 Report version 12:0:10
  3. Bishara S. Atiyeh, Michel Constagliola. Cultured epithelial autograft (CEA) in burn treatment: Three decades later. Burns, November 2006;40
  4. Rajiv Sood, MD, David Roggy, RN, Madeline Zieger, PA-C, et. al Cultured Epithelial Autografts for Coverage of Large Burn Wounds in Eighty-Eight Patients: The Indiana University Experience, J Burn Care Res, 2010;31:559-568
  5. Cuno C, Langdon R, McGuire J. Use of cultured epidermal autografts and dermal allografts as skin replacement after burn injury. Lancet. 1986;1:1123-4
  6. Rajiv Sood, MD, Beretta Craft-Coffman, PAC, Paula Fillari, RN, CCRN. Surgical Guidelines for Epicel® cultured epidermal autografts (CEA). 2015