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; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body
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: