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stack/data/cms/skin_substitute_hcpcs_reference.csv
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data: skin substitute HCPCS code universe — 286 products + 34 reference codes 
Complete skin substitute code universe built from CMS rulemaking:
- 286 Q4 product codes (Q4100-Q4397): 283 active, 3 deleted
- 34 reference codes: CPT 15271-15278 (application), C5271-C5278
  (deleted Jan 2026), historical CPT 15330-15430
- Columns: hcpcs_code, short_descriptor, product_name, manufacturer,
  category, fda_pathway, effective_date, termination_date, status, notes
- Loaded into DuckDB as skin_subs.hcpcs_universe and skin_subs.hcpcs_reference

Key finding: 213/283 active products (75%) are amniotic membrane —
the dominant category and the one most implicated in fraud cases.

FDA pathway: 249 HCT/P (Section 361), 28 510(k), 5 PMA

Refs #232
2026-03-25 01:58:07 -04:00

36 lines
6.6 KiB
CSV
Raw Blame History

"hcpcs_code","short_descriptor","code_type","body_site","wound_size","effective_date","termination_date","status","notes"
"15271","Skin substitute graft, trunk/arms/legs, <100 sq cm; first 25 sq cm or less","Application (CPT)","Trunk/arms/legs","<100 sq cm","2012-01-01","","Active","Replaced CPT 15330"
"15272","Skin substitute graft, trunk/arms/legs, <100 sq cm; each addl 25 sq cm","Application (CPT)","Trunk/arms/legs","<100 sq cm","2012-01-01","","Active","Add-on to 15271"
"15273","Skin substitute graft, trunk/arms/legs, >=100 sq cm; first 100 sq cm","Application (CPT)","Trunk/arms/legs",">=100 sq cm","2012-01-01","","Active","Replaced CPT 15331"
"15274","Skin substitute graft, trunk/arms/legs, >=100 sq cm; each addl 100 sq cm","Application (CPT)","Trunk/arms/legs",">=100 sq cm","2012-01-01","","Active","Add-on to 15273"
"15275","Skin substitute graft, face/scalp/hands/feet/genitalia, <100 sq cm; first 25 sq cm or less","Application (CPT)","Face/scalp/hands/feet/digits/genitalia","<100 sq cm","2012-01-01","","Active","Replaced CPT 15335"
"15276","Skin substitute graft, face/scalp/hands/feet/genitalia, <100 sq cm; each addl 25 sq cm","Application (CPT)","Face/scalp/hands/feet/digits/genitalia","<100 sq cm","2012-01-01","","Active","Add-on to 15275"
"15277","Skin substitute graft, face/scalp/hands/feet/genitalia, >=100 sq cm; first 100 sq cm","Application (CPT)","Face/scalp/hands/feet/digits/genitalia",">=100 sq cm","2012-01-01","","Active","Replaced CPT 15336"
"15278","Skin substitute graft, face/scalp/hands/feet/genitalia, >=100 sq cm; each addl 100 sq cm","Application (CPT)","Face/scalp/hands/feet/digits/genitalia",">=100 sq cm","2012-01-01","","Active","Add-on to 15277"
"C5271","Low cost skin substitute graft, trunk/arms/legs, <100 sq cm; first 25 sq cm or less","Application (OPPS Low-Cost)","Trunk/arms/legs","<100 sq cm","2014-01-01","2025-12-31","Deleted","Deleted effective Jan 1 2026 per CY 2026 OPPS final rule"
"C5272","Low cost skin substitute graft, trunk/arms/legs, <100 sq cm; each addl 25 sq cm","Application (OPPS Low-Cost)","Trunk/arms/legs","<100 sq cm","2014-01-01","2025-12-31","Deleted","Add-on. Deleted effective Jan 1 2026"
"C5273","Low cost skin substitute graft, trunk/arms/legs, >=100 sq cm; first 100 sq cm","Application (OPPS Low-Cost)","Trunk/arms/legs",">=100 sq cm","2014-01-01","2025-12-31","Deleted","Deleted effective Jan 1 2026"
"C5274","Low cost skin substitute graft, trunk/arms/legs, >=100 sq cm; each addl 100 sq cm","Application (OPPS Low-Cost)","Trunk/arms/legs",">=100 sq cm","2014-01-01","2025-12-31","Deleted","Add-on. Deleted effective Jan 1 2026"
"C5275","Low cost skin substitute graft, face/scalp/hands/feet/genitalia, <100 sq cm; first 25 sq cm or less","Application (OPPS Low-Cost)","Face/scalp/hands/feet/digits/genitalia","<100 sq cm","2014-01-01","2025-12-31","Deleted","Deleted effective Jan 1 2026"
"C5276","Low cost skin substitute graft, face/scalp/hands/feet/genitalia, <100 sq cm; each addl 25 sq cm","Application (OPPS Low-Cost)","Face/scalp/hands/feet/digits/genitalia","<100 sq cm","2014-01-01","2025-12-31","Deleted","Add-on. Deleted effective Jan 1 2026"
"C5277","Low cost skin substitute graft, face/scalp/hands/feet/genitalia, >=100 sq cm; first 100 sq cm","Application (OPPS Low-Cost)","Face/scalp/hands/feet/digits/genitalia",">=100 sq cm","2014-01-01","2025-12-31","Deleted","Deleted effective Jan 1 2026"
"C5278","Low cost skin substitute graft, face/scalp/hands/feet/genitalia, >=100 sq cm; each addl 100 sq cm","Application (OPPS Low-Cost)","Face/scalp/hands/feet/digits/genitalia",">=100 sq cm","2014-01-01","2025-12-31","Deleted","Add-on. Deleted effective Jan 1 2026"
"15330","Acellular dermal allograft, trunk/arms/legs; first 100 sq cm or less","Application (CPT - Historical)","Trunk/arms/legs","<=100 sq cm","2006-01-01","2011-12-31","Deleted","Replaced by 15271/15272 in 2012"
"15331","Acellular dermal allograft, trunk/arms/legs; each addl 100 sq cm","Application (CPT - Historical)","Trunk/arms/legs",">100 sq cm","2006-01-01","2011-12-31","Deleted","Replaced by 15273/15274 in 2012"
"15335","Acellular dermal allograft, face/scalp/hands/feet; first 100 sq cm or less","Application (CPT - Historical)","Face/scalp/hands/feet/digits/genitalia","<=100 sq cm","2006-01-01","2011-12-31","Deleted","Replaced by 15275/15276 in 2012"
"15336","Acellular dermal allograft, face/scalp/hands/feet; each addl 100 sq cm","Application (CPT - Historical)","Face/scalp/hands/feet/digits/genitalia",">100 sq cm","2006-01-01","2011-12-31","Deleted","Replaced by 15277/15278 in 2012"
"15340","Tissue cultured allogeneic skin substitute; first 25 sq cm or less","Application (CPT - Historical)","","<=25 sq cm","","2011-12-31","Deleted","Pre-2012 tissue-cultured allogeneic graft code"
"15360","Tissue cultured autograft; first 25 sq cm or less","Application (CPT - Historical)","","<=25 sq cm","","2011-12-31","Deleted","Pre-2012 autologous cultured skin code"
"15400","Xenograft; first 100 sq cm or less","Application (CPT - Historical)","","<=100 sq cm","","2011-12-31","Deleted","Pre-2012 xenograft application code"
"15401","Xenograft; each addl 100 sq cm","Application (CPT - Historical)","",">100 sq cm","","2011-12-31","Deleted","Pre-2012 xenograft add-on code"
"15430","Acellular xenograft implant; first 100 sq cm or less","Application (CPT - Historical)","","<=100 sq cm","","2011-12-31","Deleted","Pre-2012 acellular xenograft code"
"G0440","Skin substitute, tissue cultured; first 25 sq cm (OPPS)","Application (OPPS - Historical)","","<=25 sq cm","","2011-12-31","Deleted","Transitional OPPS code for pass-through products"
"C9363","Integra Meshed Bilayer Wound Matrix, per sq cm","Product (C-code Historical)","","","","","Deleted","Transitional pass-through C-code; replaced by Q-code"
"C9358","SurgiMend Collagen Matrix (fetal), per 0.5 sq cm","Product (C-code Historical)","","","","","Active","Bovine collagen - fetal origin"
"C9360","SurgiMend Collagen Matrix (neonatal), per 0.5 sq cm","Product (C-code Historical)","","","","","Active","Bovine collagen - neonatal origin"
"C9364","Porcine implant Permacol, per sq cm","Product (C-code Historical)","","","","2012-12-31","Deleted","Transitional pass-through C-code"
"C9365","Oasis Ultra Tri-Layer, per sq cm","Product (C-code Historical)","","","","2011-12-31","Deleted","Replaced by Q4124"
"C9366","EpiFix, per sq cm","Product (C-code Historical)","","","","2012-12-31","Deleted","Replaced by Q4131 then Q4186"
"C9367","Endoform Dermal Template, per sq cm","Product (C-code Historical)","","","","2012-12-31","Deleted","Transitional pass-through C-code"
"A2019","Kerecis Omega3 (additional code)","Product (A-code)","","","","","","Alternate code for Kerecis fish skin xenograft"
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