C5274
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 Description
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Low cost skin substitute app
HCPCS Coverage Code
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D = Special coverage instructions apply
HCPCS Action Code
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N = No maintenance for this code
HCPCS Action Effective Date
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January 01, 2014
HCPCS Code Added Date
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January 01, 2014
HCPCS Pricing Indicator Code
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53 = Statute
HCPCS Multiple Pricing Indicator Code
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A = Not applicable as HCPCS priced under one methodology
HCPCS Statute Number
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1833(t)
HCPCS Type Of Service Code
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2 = SurgeryF = Ambulatory surgical center (facility usage for surgical services)
HCPCS Anesthesia Base Unit Quantity
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0