HCPCS C5276 Code. Low cost skin substitute app

HCPCS Code: C5276
Long Description: 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 Description: Low cost skin substitute app

Original information is taken from C5276 page

Pricing Indicator Code 1: 53 – Statute
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology

Statute Number: 1833(t)

Coverage: D – Special coverage instructions apply

Berenson-Eggers Type of Service (BETOS): P5A – Ambulatory procedures - skin
Type Of Service 1: 2 – Surgery
Type Of Service 2: F – Ambulatory surgical center (facility usage for surgical services)

Anesthesia Base Unit Quantity: 0
Code Added Date: 20140101
Code Effective Date: 20140101
Action Code: N – No maintenance for this code