CMS details July 2024 update to skin substitute HCPCS codes

Wednesday, June 26, 2024

CMS recently detailed changes to Healthcare Common Procedure Coding System (HCPCS) codes for skin substitutes in the July 2024 ambulatory surgical center (ASC) payment system update.

Payments for skin substitute products that do not qualify for hospital Outpatient Prospective Payment System (OPPS) pass-through status are packaged into the OPPS payment for the associated skin substitute application procedure, according to CMS. For packaging purposes, the agency can assign these products to a high-cost or low-cost group.

High-cost skin substitutes should only be used in combination with procedures described by Current Procedural Terminology (CPT©) codes 15271-15278, according to CMS. Low-cost products should only be used in combination with procedures described by HCPCS codes C5271-C5278.

In addition, all OPPS pass-through skin substitute products should be billed in combination with CPT codes 15271-15278.

In the recent update, CMS added 23 new skin substitute HCPCS codes that will take effect on July 1. New codes are assigned to the low-cost group unless there is pricing data to show the product cost is above the mean unit cost of $47 or the per day cost of $807 for 2024. Out of the new HCPCS codes, only Q4331 and Q4332 were assigned to the high-cost group. Skin substitute HCPCS codes Q4210 and Q4277 will be deleted effective June 30.

Revenue integrity professionals can review Medicare Claims Processing Transmittal 12673 for more information on skin substitutes and other changes in the July 2024 update to the ASC payment system.