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Official Description

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children
Short Descr Low cost skin substitute app
Coverage Special coverage instructions apply
Pricing Indicator(s) 53 – Statute
MPI A – Not applicable, as HCPCS priced under one methodology
Statute 1833(t)
ASC Payment Group Code YY – 1/01/2014
BETOS P5A – Ambulatory procedures - skin
TOS Code(s) 2 – Surgery
Added Date 1/1/2014
APC Status Indicator Procedure or Service, Multiple Reduction Applies
ASC Payment Indicator Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
MUE 1
MUE Not applicable/unspecified.
OTS Orthotic No
Date
Action
Notes
2014-01-01 Added Added
Code
Description
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