REIMBURSEMENT GUIDE:

MatrixWAVE™ MMF System

A novel system that expands and compresses

to achieve maxillomandibular fi xation

DePuy Synthes CMF Coding Hotline 888-877-8152

The appropriate physician coding for the use of MatrixWAVE™ MMF System has been researched in an effort to provide physicians with coding guidance. The research performed has warranted the following guidelines.

Outlined below are some procedural examples with their corresponding CPT codes for physician coding.

Comment:In some instances the above listed procedures may be performed with another separately identifiable procedure. When this occurs, the code with the highest relative value should be listed as the primary procedure and modifier -51; multiple procedures may be appended to any additional procedures.

CPT Copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA). The AMA assumes no liability for data contained or not contained herein.

Physician national reimbursement levels are based on the Medicare Physician Fee Schedule as published in the Medicare Program: Revisions to Payment Policies, etc; Final Rule. Federal Register, December 10, 2013 and the Pathway for SGR Reform Act of 2013.

MatrixWAVE MMF System

PHYSICIAN REIMBURSEMENT

CPT CODE CPT DESCRIPTION2014 RVU (FACILITY)

2014 NATIONAL AVERAGE MEDICARE PAYMENT (FACILITY)

2014 RVU (NON-FACILITY)

2014 NATIONAL AVERAGE MEDICARE PAYMENT (NON-FACILITY)

21345 Closed treatment of nasomaxillary complex fracture (LeFort II type), with interdental wire fixation or fixation of denture or splint

17.88 $641 22.15 $793

21421 Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint

18.59 $666 21.93 $786

21431 Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splint

20.74 $743 N/A N/A

21453 Closed treatment of mandibular fracture with interdental fixation

22.51 $806 26.23 $940

21462 Open treatment of mandibular fracture; with interdental fixation

29.95 $1,073 64.90 $2,325

21470 Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints

35.02 $1,255 NA NA

20670 Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)

4.20 $150 10.67 $382

20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

12.15 $435 17.55 $629

DePuy Synthes CMF Coding Hotline 888-877-8152

MatrixWAVE MMF System

HOSPITAL OUTPATIENT/AMBULATORY SURGERY CENTER REIMBURSEMENT

CPT CODE CPT DESCRIPTION APC

2014 NATIONAL AVERAGE HOSPITAL OUTPATIENT PAYMENT1

2014 NATIONAL AVERAGE MEDICARE ASC PAYMENT1

21345 Closed treatment of nasomaxillary complex fracture (LeFort II type), with interdental wire fixation or fixation of denture or splint

0254 $1,859 $1,027

21421 Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint

0256 $3,565 $1,969

21431 Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splint

N/A N/A N/A

21453 Closed treatment of mandibular fracture with interdental fixation

0256 $3,565 $1,969

21462 Open treatment of mandibular fracture; with interdental fixation

0256 $3,565 $1,969

21470 Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints

0256 $3,565 NA

20670 Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)

0021 $1,146 $633

20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

0022 $1,737 $959

ICD-9-CM DIAGNOSIS CODES

Claim forms submitted for payment must include a supporting ICD-9-CM diagnosis code. The provider should always report the patient’s diagnosis that supports their reasoning for providing the medical services.

If you have any additional questions regarding coding for the MatrixWAVE MMF System or any other DePuy Synthes CMF device, please call the DePuy Synthes CMF coding hotline at 1-888-877-8152.

1 Outpatient Hospital and Ambulatory Surgery Center national reimbursement levels are based on the Medicare Outpatient Prospective Payment System and Ambulatory Surgery Center Payment System as published in the December 10, 2013 Federal Register (Medicare Program: Hospital Outpatient Prospective Payment System and Ambulatory Surgical Payment System ... Final Rule).

2 Inpatient national reimbursement levels are based on the Medicare Inpatient Prospective System as published in the 08/22/14 Federal Register (Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates)…

HOSPITAL INPATIENT

MS-DRG CODE MS-DRG DESCRIPTION

2015 NATIONAL AVERAGE MEDICARE HOSPITAL INPATIENT PAYMENT2

131 Cranial/Facial Procedures with CC/MCC $13,903

132 Cranial/Facial Procedures without CC/MCC $8,357

© DePuy Synthes CMF, a division of DOI 2014. All rights reserved. DSUS/CMF/1014/0237

Synthes USA Products, LLC1302 Wrights Lane EastWest Chester, PA 19380Telephone: (610) 719-5000To order: (800) 523-0322

www.depuysynthes.com

The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by DePuy Synthes CMF, concerning levels of reimbursement, payment, or charge. Similarly, all CPT© (AMA), ICD-9, ICD-10, HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by the Company that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payer. We strongly recommend that you consult your payer organization with regard to its reimbursement policies. Current Procedural Terminology ©2014 American Medical Association. All rights reserved.