Optimum Medical LLC
2026 Reimbursement Guide
Membrane Wrap™ | Membrane Wrap - Lite™ | Microlyte® SAM™
General Information & Reimbursement Disclaimer
This information is for educational/informational purposes only and should not be construed as authoritative. The information presented here is based on publicly available source information. Codes and values are subject to frequent change without notice. The entity billing Medicare and/or third-party payers is solely responsible for the accuracy of the codes assigned to the services or items in the medical record. When making coding decisions, 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 billed to payers must be medically necessary and supported by appropriate documentation.
Reimbursement and coverage eligibility for the use of Optimum Medical Amniotic Membranes and associated procedures vary by Medicare and private payers. Coverage policies, prior authorizations, contract terms, billing edits, and site of service influence reimbursement.
Place of Service (POS) Codes
POS codes are 2-digit numbers included on healthcare professional claims to indicate the setting in which a service was provided. The Centers for Medicare and Medicaid Services (CMS) maintain POS codes used throughout the healthcare industry. Listed below are POS codes and descriptions typically applicable to our products. These codes should be used on professional claims to specify the entity where services were rendered. Check with individual payers for reimbursement policies regarding these codes.
Place of Service Code 11 - Office: Location other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, state or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnoses, and treatment of illness or injury on an ambulatory basis.
Place of Service Code 12 - Home: Location, other than a hospital or other facility, where the patient receives care in a private residence.
Place of Service Code 32 - Nursing Facility: A facility that primarily provides residents with skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or health-related care services above the level of custodial care to individuals other than those with intellectual disabilities.
Coding for Providers in Office Settings
The Medicare National Average for HCPCS Codes Q4205, A2005 & Q4373 are priced based on the physician fee schedule. The Medicare PART B physician fee schedule can be located on CMS.gov and can be found at the link below:
https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files/rvu26a
For Wounds on Trunk, Arms, or Legs
| CPT | Description | 2026 Medicare National Average Payments Physician Office Fee |
|---|---|---|
| 15271 | Application of skin substitute graft trunk, arms, legs, total surface area up to 100 sq cm, first 25 sq cm or less wound surface area | $157.99 |
| +15272 | Each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure) | $25.72 |
| 15273 | Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm wound surface area, or 1% of body area of infants and children | $321.96 |
| +15274 | Each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (List separately in addition to code for primary procedure) | $86.84 |
+ Add-on code
For Wounds on Face, Scalp, Eyelids, Mouth, Neck, Ears, Orbits, Genitalia, Hands, Feet and/or Multiple Digits
| CPT | Description | 2026 Medicare National Average Payments Physician Office Fee |
|---|---|---|
| 15275 | Application of skin substitute graft to Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area | $160.32 |
| +15276 | Each additional 25 cm2 wound surface area, or part thereof (List separately in addition to code for primary procedure) | $33.73 |
| 15277 | Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm wound surface area, or 1% of body area of infants and children | $361.40 |
| +15278 | Each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (List separately in addition to code for primary procedure) | $101.20 |
+ Add-on code
Q4205 | MEMBRANE WRAP™
Ordering Information
Optimum Medical Membrane Wrap™ is a readily available amnion-amnion human tissue allograft derived from the amniotic membrane that serves as a barrier and provides protective covering for the wound. It is minimally manipulated, preserving the properties exhibited in its natural state, while remaining compliant with FDA Regulations.
*All Optimum Medical Membrane Wrap™ allograft tissue products have been tested for potentially infectious diseases and terminally sterilized to ensure the safety of each membrane.
| Membrane Wrap Size (cm) | SKU | Product Listing Code | Wound Coverage |
|---|---|---|---|
| 2x3 | MW0203 | 50016-091607 | 6 sq cm |
| 4x4 | MW0404 | 50016-091608 | 16 sq cm |
| 4x6 | MW0406 | 50016-091609 | 24 sq cm |
| 4x8 | MW0408 | 50016-091610 | 32 sq cm |
| 6x8 | MW0608 | 50016-091617 | 48 sq cm |
Understanding Membrane Wrap™
Billing Units: billed by graft size
Membrane Wrap™ is indicated for acute and chronic wounds.
Please refer to your locality to determine the appropriate wage index to your MAC region.