HCPCS C5273 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Outpatient PPS • Skin Substitute Graft Application |
| Complexity Level | High |
National average reimbursement for HCPCS C5273 by major payers:
$1,307.81
$271.76
$2,021.22
$1,037.47
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS C5273 | ||||||
United | C5273 | $7252.00 | 1598766495 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER,INC | 720423635 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER INC | LA | General Acute Care Hospital (282N00000X) |
United | C5273 | $1752.00 | 1265437644 - WEST JEFFERSON HOLDINGS, LLC, WEST JEFFERSON MEDICAL CENTER | 472667968 - WEST JEFFERSON HOLDINGS, LLC | LA | General Acute Care Hospital (282N00000X) |
United | C5273 | $559.00 | 1649921065 - JOINT REPLACEMENT CENTER OF LOUISIANA | 874022126 - (LA) JOINT REPLACEMENT CENTER OF LOUS | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5273 | $6364.00 | 1477500015 - RAPIDES HEALTHCARE SYSTEM, L.L.C., RAPIDES REGIONAL MEDICAL CENTER | 611267229 | LA | General Acute Care Hospital (282N00000X) |
United | C5273 | $726.00 | 1407883341 - LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1, LADY OF THE SEA GENERAL HOSPITAL | 726012041 - (LA) LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO 1 | LA | Critical Access Hospital (282NC0060X) |
United | C5273 | $735.00 | 1003062274 - ADVANCED SURGICAL CARE OF BATON ROUGE,LLC | 261476056 - (LA) ADVANCED SURGICAL CARE OF BATON ROUGELLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5273 | $451.00 | 1376540153 - ACADIA-ST. LANDRY HOSPITAL SERVICE DISTRICT, ACADIA-ST. LANDRY HOSPITAL | 720643190 | LA | Critical Access Hospital (282NC0060X) |
United | C5273 | $3130.00 | 1164750840 - CENTRAL LOUISIANA SURGICAL HOSPITAL LLC, CHRISTUS CENTRAL LOUISIANA SURGICAL HOSPITAL | 264732898 - (LA) CENTRAL LOUISIANA SURGICAL HOSPITAL, LLC | LA | General Acute Care Hospital (282N00000X) |
United | C5273 | $6364.00 | 1568802288 - RAPIDES REGIONAL MEDICAL CENTER | 611267229 | LA | General Acute Care Hospital (282N00000X) |
United | C5273 | $730.00 | 1669882940 - ACADIA GENERAL HOSPITAL, INC., ACADIA GENERAL HOSPITAL | 464958152 - (LA) ACADIA GENERAL HOSPITAL INC | LA | General Acute Care Hospital (282N00000X) |
United | C5273 | $556.00 | 1134427297 - SURGERY CENTER OF ZACHARY, LLC | 811928790 - (LA) SURGERY CENTER OF ZACHARY, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5273 | $386.00 | 1386793370 - SURGERY CENTER OF WEST MONROE, LLC | 721509507 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5273 | $1244.66 | 1891873337 - CLHG, MINDEN MEDICAL CENTER | 824625698 | LA | Rural Acute Care Hospital (282NR1301X) |
United | C5273 | $4363.00 | 1720133234 - OCHSNER BAYOU, LLC, OCHSNER ST ANNE GENERAL HOSPITAL | 204670876 - (LA) OCHSNER BAYOU, LLC | LA | Critical Access Hospital (282NC0060X) |
United | C5273 | $517.00 | 1780865634 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND TERAPEUTIC CENTER | 205904530 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS C5273 vs. Other Skin Substitute Graft Application Codes
The HCPCS C5273 code is part of the Outpatient PPS services used for Skin Substitute Graft Application. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS C5273 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| C5272-HCPCS | Low | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure) |
| C5273-HCPCS | High | Application of low cost skin substitute graft to trunk, arms, legs, 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 |
| C5274-HCPCS | Low | Application of low cost skin substitute graft to trunk, arms, legs, 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 area of infants and children, or part thereof (list separately in addition to code for primary procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C5273. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C5273 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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