C5274 Insurance Policy Changes

HCPCS C5274 is officially defined as "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)." HCPCS C5274 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 C5274 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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