However, at this time, there is no national Medicare/Medicaid policy nor code, so for Medicare, each state (subcontractor) has the right to make its own determination about the level of reimbursement.

The American Medical Association (AMA) Committee on CPT Coding issued the following coding recommendations in September, 2008 (CPT Assistant, V8 N9):

• Maggot Therapy: 97602 Non-excisional debridement


• Medicinal maggots and the other dressings used: Use CPT supply code 99070 and list each significant item.

Specifically, the AMA committee wrote, in part:

"The supply of the maggots should be reported in addition to the wound management code 97602 with CPT supply code 99070, Supplies and materials provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)."

The BioTherapeutics, Education and Research (BTER) Foundation issued coding recommendation in 2006 (based on earlier recommendations by AMA, the Center for Medicare and Medicaid Services [CMS], and ABC Coding Solutions). Those recommendations are now updated, and offered here:

Procedure Codes -

• CPT Codes - 97597 ("Removal of devitalized tissue from wounds[s], selective debridement, without anesthesia [eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], with or without topical application[s], wound assessment, and instruction[s] for ongoing care, may include use of a whirlpool, per session; total wound[s] surface area less than or equal to 20 square centimeters") or 97598 ("Removal of devitalized tissue from wounds[s], selective debridement, without anesthesia [eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], with or without topical application[s], wound assessment, and instruction[s] for ongoing care, may include use of a whirlpool, per session; total wound[s] surface area greater than 20 square centimeters")


• ABC Codes (alternative coding for non-physicians) - NAAFT ("Maggot therapy application, each site. Applying medicinal maggots and bandaging a patient's body part or region to clean nonhealing wound[s]") and NAAFU ("Maggot therapy removal, each site. Removing medicinal maggots from a patient's body part or region and rebandaging his or her wound[s]").

Supply Codes (choose one of the following) -

• CPT Codes - supply code 99070 (Supplies and materials provided by the physician over and above those usually included with the office visit or other services rendered). List each item (maggots, dressings materials, etc) required, since these can add up to be as great as the procedure reimbursement, itself.


• ABC Codes (alternative coding for non-physicians) - EAACT ("Medicinal disinfected maggots"). For any other dressing items, their ABC or HCPCS code should be used.


• HCPCS Codes - A9270 ("non-covered item"); be sure to include the following details: 1) the specific clinical indications (justification) for their use; 2) their cost (which exceeds the reimbursement provided for the procedure itself); and 3) the fact that the product has marketing clearance. For all other dressing materials with specific HCPCS or ABC codes, list their codes, too. (This HCPCS code is no longer recommended by the BTER Foundation, but it may be an alternative if neither the CPT Supply code nor the ABC code are acceptible.)

Note: Therapists and their institutions are ultimately responsible for selecting the appropriate billing codes, as dictated by the clinical indication, the procedure and supplies used, and the policies of third party payors.

For those patients who do not have medical insurance coverage, or whose covereage refuses to pay for the maggots, Monarch Labs has agreed to accept BTER Foundation Patient Assistance Grants in lieu of payment. Information and applications for BTER Foundation Patient Assistance Grants can be found at: www.BTERFoundation.orb/indexfiles/pt_assist.htm


If your patients' third party payor refuses to compensate you for your maggot therapy services (procedure and/or supplies), be sure to inform us or the BTER Foundation immediately. The BTER Foundation aims to address non-payments by working with you to create an effective appeal. Should that fail, the BTER Foundation intends to work directly with the administration of that particular payor in order to improve their reimbursement policy. Read more about biotherapy reimbursement and the BTER Foundation's efforts at: www.BTERFoundation.org.