New codes and updates for outpatient skin substitute claims

CMS added new Healthcare Common Procedure Coding System (HCPCS) codes and made status indicator (SI) and code descriptor changes for outpatient skin substitute claims. These changes will be included in the January 2025 Integrated Outpatient Code Editor (I/OCE) update, and their effective date is  October 1, 2024.

CMS added HCPCS codes A2027-A2029 to the high-cost group and SI “N.” It also corrected the following errors in the October 2024 I/OCE:

• HCPCS code Q5131 was incorrectly assigned to SI “E2”
  
  • Reassigned to SI “K” and ambulatory payment classification 0787
• HCPCS code J9059 was incorrectly assigned to SI “K”
  
  • Reassigned to SI “E1”
• HCPCS code J9072 was incorrectly assigned to SI “G”
  
  • Reassigned to SI “E2”

The agency also changed the code descriptors for HCPCS code A2024 to the following:

• Long descriptor: Resolve matrix or xenopatch, per square centimeter
• Short descriptor: Resolve or xenopatch sq cm

Revenue integrity professionals should ensure their outpatient skin substitute claims are compliant with CMS requirements and incorporate these changes if necessary. Monitor CMS’ I/OCE web page for the release of the January 2025 I/OCE update files.

Editor’s note: Find more NAHRI resources on skin substitute billing and coding here.