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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
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6.6 KiB
| 1 | hcpcs_code | short_descriptor | code_type | body_site | wound_size | effective_date | termination_date | status | notes |
|---|---|---|---|---|---|---|---|---|---|
| 2 | 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 | |
| 3 | 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 | |
| 4 | 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 | |
| 5 | 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 | |
| 6 | 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 | |
| 7 | 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 | |
| 8 | 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 | |
| 9 | 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 | |
| 10 | 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 |
| 11 | 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 |
| 12 | 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 |
| 13 | 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 |
| 14 | 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 |
| 15 | 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 |
| 16 | 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 |
| 17 | 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 |
| 18 | 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 |
| 19 | 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 |
| 20 | 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 |
| 21 | 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 |
| 22 | 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 | ||
| 23 | 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 | ||
| 24 | 15400 | Xenograft; first 100 sq cm or less | Application (CPT - Historical) | <=100 sq cm | 2011-12-31 | Deleted | Pre-2012 xenograft application code | ||
| 25 | 15401 | Xenograft; each addl 100 sq cm | Application (CPT - Historical) | >100 sq cm | 2011-12-31 | Deleted | Pre-2012 xenograft add-on code | ||
| 26 | 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 | ||
| 27 | 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 | ||
| 28 | C9363 | Integra Meshed Bilayer Wound Matrix, per sq cm | Product (C-code Historical) | Deleted | Transitional pass-through C-code; replaced by Q-code | ||||
| 29 | C9358 | SurgiMend Collagen Matrix (fetal), per 0.5 sq cm | Product (C-code Historical) | Active | Bovine collagen - fetal origin | ||||
| 30 | C9360 | SurgiMend Collagen Matrix (neonatal), per 0.5 sq cm | Product (C-code Historical) | Active | Bovine collagen - neonatal origin | ||||
| 31 | C9364 | Porcine implant Permacol, per sq cm | Product (C-code Historical) | 2012-12-31 | Deleted | Transitional pass-through C-code | |||
| 32 | C9365 | Oasis Ultra Tri-Layer, per sq cm | Product (C-code Historical) | 2011-12-31 | Deleted | Replaced by Q4124 | |||
| 33 | C9366 | EpiFix, per sq cm | Product (C-code Historical) | 2012-12-31 | Deleted | Replaced by Q4131 then Q4186 | |||
| 34 | C9367 | Endoform Dermal Template, per sq cm | Product (C-code Historical) | 2012-12-31 | Deleted | Transitional pass-through C-code | |||
| 35 | A2019 | Kerecis Omega3 (additional code) | Product (A-code) | Alternate code for Kerecis fish skin xenograft |