|
C5271 |
 |
Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area
| short | Low cost skin substitute app |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
|
|
|
|
C5272 |
|
Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)
| short | Low cost skin substitute app |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 3.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
|
|
|
|
C5273 |
|
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 | Low cost skin substitute app |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
|
|
|
|
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 | Low cost skin substitute app |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 35.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 35.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
C5275 |
|
Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area
| short | Low cost skin substitute app |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
|
|
|
|
C5276 |
|
Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)
| short | Low cost skin substitute app |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 3.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
|
|
|
|
C5277 |
|
Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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 | Low cost skin substitute app |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
|
|
|
|
C5278 |
|
Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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 | Low cost skin substitute app |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 15.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 15.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|