| HCPCS Code: |
C5273 |
| Long 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 Description: |
Low cost skin substitute app |
| Pricing Indicator 1: |
53 (Statute) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| Statute Number: |
1833(t) |
| Coverage Code: |
D (Special coverage instructions apply) |
| ASC Payment Group Code: |
YY |
| ASC Payment Group Date: |
01-01-2014 |
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
P5A (Ambulatory procedures - skin) |
| Type of Service Code 1: |
2 (Surgery) |
| Type of Service Code 2: |
F (Ambulatory surgical center (facility usage for surgical services)) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-2014 |
| Action Effective Date: |
01-01-2014 |
| Action Code: |
A (Add procedure or modifier code) |
