Skin substitute coding changes in the April 2025 OPPS update

CMS recently published the April 2025 update of the Outpatient Prospective Payment System (OPPS) to highlight coding changes for skin substitute products that took effect on April 1.

The agency packages payment for skin substitute products that do not qualify for pass-through status into the payment for the associated application procedure. In the latest update, it established 14 new Healthcare Common Procedure Coding System (HCPCS) codes (Q4354–Q4367) for skin substitute products, all assigned to status indicator “N.”

These codes were assigned to the low-cost skin substitute group, as CMS did not have pricing data demonstrating that their cost is above the mean unit cost of $50 or the per-day cost of $833 for calendar year 2025. Other skin substitute coding changes include the deletion of HCPCS code Q4231 and the reassignment of Q4271 to the high-cost group.

The April 2025 OPPS update also includes coding changes for certain COVID-19 monoclonal antibody therapy products, proprietary laboratory analyses, and more. Revenue integrity professionals can find tables that list the codes and their descriptors in Medicare Claims Processing Transmittal 13135.