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HCPCS Code C5274

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; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)

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)
BETOS	P5A – Ambulatory procedures - skin
TOS Code(s)	2 – Surgery
Added Date	1/1/2014
APC Status Indicator	Items and Services Packaged into APC Rates
ASC Payment Indicator	Packaged service/item; no separate payment made.
MUE	35
MUE	Not applicable/unspecified.
OTS Orthotic	No

C1052-C9898 Temporary Hospital Outpatient PPS

C1768-C9363 Wound Care Management Products/Grafts Services/Supplies

C5271-C5278 Application of low cost skin substitute graft

C5271 Low cost skin substitute app

C5272 Low cost skin substitute app

C5273 Low cost skin substitute app

C5274 Low cost skin substitute app

C5275 Low cost skin substitute app

C5276 Low cost skin substitute app

C5277 Low cost skin substitute app

C5278 Low cost skin substitute app

Date	Action	Notes
2014-01-01	Added	Added

Code	Description

No matching codes found

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