C5277

Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Short Description: Low cost skin substitute app

Coverage Code: Special coverage instructions apply

Action Code: No maintenance for this code

Date Added: January 1, 2014

Effective Date: January 1, 2014

Termination Date:

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