C5278 Insurance Policy Changes

HCPCS C5278 is officially defined as "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)." HCPCS C5278 is referenced in 1 tracked payer policy change from Independence Blue Cross. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS C5278 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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All billing codesJ3590C9399J3490992139921499212

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