HCPCS C5274 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Outpatient PPS • Skin Substitute Graft Application |
| Complexity Level | Low |
National average reimbursement for HCPCS C5274 by major payers:
$21.05
$54.00
$187.38
$N/A
| 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 C5274 | ||||||
United | C5274 | $1044.00 | 1760696546 - ST CHARLES PARISH HOSPITAL | 726014606 | LA | General Acute Care Hospital (282N00000X) |
United | C5274 | $341.00 | 1306849617 - WEST ASCENSION PARISH HOSPITAL SERVICE DISTRICT, PREVOST MEMORIAL HOSPITAL | 720637478 | LA | Critical Access Hospital (282NC0060X) |
United | C5274 | $80.00 | 1801949631 - THIBODAUX SURGERY CENTER, LLC, BAYOU REGION SURGICAL CENTER | 320165642 - (LA) THIBODAUX SURGERY CENTER, LLC DBA BAYOU REGION SURGICAL CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5274 | $820.00 | 1871927921 - BRFHH SHREVEPORT, LLC | 831173631 | LA | General Acute Care Hospital (282N00000X) |
United | C5274 | $774.00 | 1467574202 - CHRISTUS HEALTH CENTRAL LOUISIANA, CHRISTUS COUSHATTA HEALTH CARE CENTER | 720408984 - (LA) CHRISTUS HEALTH CENTRAL LOUISIANA | LA | Critical Access Hospital (282NC0060X) |
United | C5274 | $390.00 | 1548796378 - CHRISTUS HEALTH SOUTHWESTERN LOUISIANA, CHRISTUS OCHSNER LAKE AREA HOSPITAL | 720411322 - (LA) CHRISTUS HEALTH SOUTHWESTERN LOUISIANA | LA | General Acute Care Hospital (282N00000X) |
United | C5274 | $1741.00 | 1598719643 - COLISEUM MEDICAL CENTER, LLC, PIEDMONT MACON MEDICAL CENTER | 621736983 - (GA) COLISEUM MEDICAL CENTER LLC | GA | General Acute Care Hospital (282N00000X) |
United | C5274 | $2538.00 | 1174506943 - WEST GEORGIA HEALTH SYSTEM | 205497506 - (GA) WEST GEORGIA MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | C5274 | $2126.00 | 1982600540 - UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC., PIEDMONT MCDUFFIE HOSPITAL | 454166209 - (GA) UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | C5274 | $1676.00 | 1760498588 - PIEDMONT NEWTON HOSPITAL, INC., NEWTON MEDICAL CENTER | 582155150 - (GA) PIEDMONT NEWTON HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | C5274 | $1518.00 | 1962461681 - PIEDMONT HOSPITAL, INC, PIEDMONT HOSPITAL | 580566213 - (GA) PIEDMONT HEALTHCARE INC | GA | General Acute Care Hospital (282N00000X) |
United | C5274 | $1488.00 | 1871771923 - EMORY UNIVERSITY HOSPITAL | 580566256 - (GA) EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | C5274 | $1488.00 | 1316158793 - ST. JOSEPH'S HOSPITAL | 580566257 - (GA) SAINT JOSEPHS HOSPITAL OF ATLANTA INC | GA | Critical Access Hospital (282NC0060X) |
United | C5274 | $2538.00 | 1649248626 - KENNESTONE HOSPITAL, INC., WELLSTAR KENNESTONE HOSPITAL | 582032904 - KENNESTONE HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | C5274 | $1265.00 | 1588640692 - EMORY UNIVERSITY, EMORY UNIVERSITY HOSPITAL | 580566200 | GA | General Acute Care Hospital (282N00000X) |
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 C5274 vs. Other Skin Substitute Graft Application Codes
The HCPCS C5274 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 C5274 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 |
|---|---|---|
| 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) |
| C5275-HCPCS | Moderate | 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 up to 100 sq cm; first 25 sq cm or less wound surface area |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C5274. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C5274 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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