Summary & Overview
HCPCS C5276: Low Cost Skin Substitute Graft Application, Up to 100 sq cm
HCPCS Level II code C5276 identifies the application of a low cost skin substitute graft to complex and functionally sensitive anatomical sites — including the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and multiple digits — for wound areas up to 100 square centimeters, with add-on billing for each additional 25 sq cm. This procedure code matters nationally as use of skin substitutes intersects topical biologic therapy, reconstructive wound management, and outpatient procedural billing where accurate coding affects clinical documentation and payer reimbursement.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides readers with benchmarks on utilization and coding practice (where available), summaries of payer coverage trends, and clinical context around typical service settings and indications for application of low cost skin substitutes. Readers will find concise guidance on what the code denotes, typical sites of service, and what to expect in payer coverage language. Data not available in the input is noted where applicable. This resource is intended for billing professionals, practice managers, and clinicians seeking a clear national overview of HCPCS Level II code C5276 and its role in wound care and procedural coding.
Billing Code Overview
HCPCS Level II code C5276 describes the application of a low cost skin substitute graft to wounds located on the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits for a total wound surface area up to 100 sq cm. The code also notes billing for each additional 25 sq cm (or part thereof) as an add-on when reported separately from the primary procedure.
Service type: Wound care / skin substitute application procedure
Typical site of service: Ambulatory surgical centers, hospital outpatient departments, specialty clinics (dermatology, plastic surgery, wound care centers), and other procedural settings where skin grafting or topical biologic applications are performed.
Clinical & Coding Specifications
Clinical Context
A 58-year-old male presents to an outpatient wound care clinic with a 5 cm traumatic full-thickness skin loss on the dorsal hand after a machinery injury. After initial debridement and hemostasis, the reconstructive plan includes application of a low-cost skin substitute graft to the hand to cover the wound base and promote granulation and epithelialization. The procedure is performed in an ambulatory surgery center under local anesthesia with sedation. Wound measurement documents a total surface area of 45 sq cm, so primary billing uses C5276 for the first up to 100 sq cm. The patient’s chart documents the diagnosis of infected traumatic wound and prior failed primary closure attempts.
Clinical workflow steps:
-
Pre-procedure evaluation and informed consent, including review of wound measurements and indication for biologic skin substitute.
-
Surgical preparation, irrigation, and debridement of nonviable tissue.
-
Hemostasis and measurement of total wound surface area.
-
Application and fixation of the low-cost skin substitute graft to the wound bed; any additional product or placement documented if beyond the first 100 sq cm.
-
Post-application dressing and wound care instructions; scheduled follow-up visits for graft assessment and dressing changes.
-
Documentation to support medical necessity, product lot numbers, wound dimensions, and any complicating factors (infection, comorbidities) for payer review.