| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
C5276 |
| HCPCS Sequence Number |
0010 |
| HCPCS Record Identification Code |
3 - First line of procedure record also contains detail information in positions 92-275 |
| HCPCS 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) |
| HCPCS Short Description |
Low cost skin substitute app |
| HCPCS Pricing Indicator Code 1 |
53 - Statute |
| HCPCS Multiple Pricing Indicator Code |
A - Not applicable as HCPCS priced under one methodology |
| HCPCS Statute Number |
1833(t) |
| HCPCS Coverage Code |
D - Special coverage instructions apply |
| HCPCS Berenson-Eggers Type Of Service Code |
P5A - Ambulatory procedures - skin |
| HCPCS Type Of Service Code 1 |
2 - Surgery |
| HCPCS Type Of Service Code 2 |
F - Ambulatory surgical center (facility usage for surgical services) |
| HCPCS Anesthesia Base Unit Quantity |
0 |
| HCPCS Code Added Date |
1/1/2014 |
| HCPCS Action Effective Date |
1/1/2014 |
| HCPCS Action Code |
N - No maintenance for this code |