HCPCS C5275 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 | Moderate |
National average reimbursement for HCPCS C5275 by major payers:
$471.14
$106.91
$40.94
$250.39
| 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 C5275 | ||||||
United | C5275 | $1265.00 | 1679664395 - SAINT JOSEPHS HOSPITAL OF ATLANTA INC | 580566257 - (GA) SAINT JOSEPHS HOSPITAL OF ATLANTA INC | GA | General Acute Care Hospital (282N00000X) |
United | C5275 | $678.00 | 1962024026 - CLHG-RUSTON LLC | 844422249 | LA | General Acute Care Hospital (282N00000X) |
United | C5275 | $92.00 | 1780865634 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND TERAPEUTIC CENTER | 205904530 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5275 | $94.00 | 1154318376 - LAHAYE CENTER FOR ADVANCED EYE CARE OF LAFAYETTE, INC. | 721227426 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5275 | $434.00 | 1114929957 - OPHTHALMIC OUTPATIENT SURGERY CENTER PARTNERS, LLC, OUTPATIENT SURGERY CENTER FOR SIGHT | 721405960 - (LA) OPHTHALMIC OUTPATIENT SURGERY CENTER PARTNERS LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5275 | $92.00 | 1134300080 - METAIRIE LA ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND THERAPEUTIC CENTER-METAIRIE | 205904604 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5275 | $163.00 | 1861458507 - BRASS PARTNERSHIP IN COMMENDAM | 721097827 - (LA) BRASS PARTNERSHIP IN COMMENDAM | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5275 | $108.00 | 1003062274 - ADVANCED SURGICAL CARE OF BATON ROUGE,LLC | 261476056 - (LA) ADVANCED SURGICAL CARE OF BATON ROUGELLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5275 | $190.00 | 1992788772 - EAST JEFFERSON AMBULATORY SURGERY CENTER | 201425074 - (LA) EAST JEFFERSON AMBULATORY | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5275 | $1570.00 | 1063406684 - SAINT JOSEPH'S HOSPITAL, INC. | 580568702 - (GA) SAINT JOSEPHS HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | C5275 | $1860.00 | 1528069218 - NORTHSHORE REGIONAL MEDICAL CENTER DBA THE SURGERY SUITE, THE SURGERY SUITE | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5275 | $121.00 | 1669586376 - JEFFERSON AMBULATORY SURGERY CENTER LLC | 202349222 - (LA) JEFFERSON AMBULATORY SURGERY C | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5275 | $100.00 | 1922178169 - IMPERIAL HEALTH, LLP | 721005645 - (LA) IMPERIAL HEALTH, LLP | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5275 | $420.00 | 1184697930 - THE ALEXANDRIA OPHTHALMOLOGY ASC LLC, WALLACE LASER AND SURGERY CENTER | 752830937 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5275 | $79.00 | 1720262405 - BATON ROUGE LA ENDOSCOPY ASC LLC, LOUISIANA ENDOSCOPY CENTER | 261168310 | 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 C5275 vs. Other Skin Substitute Graft Application Codes
The HCPCS C5275 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 C5275 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 |
|---|---|---|
| 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 |
| C5276-HCPCS | Low | 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; each additional 25 sq cm wound surface area, 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 C5275. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C5275 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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