HCPCS code 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)
What C5274 means
C5274 (Low cost skin substitute app) belongs to the HCPCS Level II C series (Outpatient Prospective Payment System (OPPS)). Its Medicare coverage status is Special coverage instructions apply. Review the relevant Medicare manual or National Coverage Determination before billing.
Part B pricing: Statute.
Code details
- Short description
- Low cost skin substitute app
- Coverage code
- D = Special coverage instructions apply
- Pricing indicator
- 53 = Statute
- Multiple pricing indicator
- A = Not applicable as HCPCS priced under one methodology
- Type of service
- 2 = Surgery F = Ambulatory surgical center (facility usage for surgical services)
- Action code
- D = Discontinue procedure or modifier code
- Action effective date
- January 01, 2026
- Code added date
- January 01, 2014
- Data year
- 2026
Questions about C5274
What is HCPCS code C5274?
HCPCS code C5274 is a Level II code in the C series (Outpatient Prospective Payment System (OPPS)). Its full description is: "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)"
Is C5274 a CPT code?
No. C5274 is a HCPCS Level II code maintained by CMS, not a CPT (Level I) code from the American Medical Association. People often search for it as a CPT code because both code sets are reported on the same claims.
Does Medicare cover HCPCS code C5274?
The Medicare coverage code for C5274 is "Special coverage instructions apply". Review the relevant Medicare manual or National Coverage Determination before billing.
When was HCPCS code C5274 added?
C5274 was added to the HCPCS code set on January 01, 2014. The most recent action on it (Discontinue procedure or modifier code) took effect on January 01, 2026.
Nearby C codes
All C codes- C2698Brachytherapy source, stranded, not otherwise specified, per source
- C2699Brachytherapy source, non-stranded, not otherwise specified, per source
- C5271Application 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
- C5272Application 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)
- C5273Application 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
- C5275Application 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
- C5276Application 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)
- C5277Application 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
- C5278Application 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)
- C7500Debridement, bone including epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed, first 20 sq cm or less with manual preparation and insertion of deep (e.g., subfacial) drug-delivery device(s)