HCPCS C5277 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 C5277 by major payers:
$504.41
$106.91
$652.34
$318.19
| 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 C5277 | ||||||
United | C5277 | $1265.00 | 1679632137 - EHCA JOHNS CREEK, LLC, EMORY JOHNS CREEK HOSPITAL | 582433436 | GA | General Acute Care Hospital (282N00000X) |
United | C5277 | $1756.00 | 1457396079 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL | 581954432 - (GA) NORTHSIDE HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | C5277 | $1792.00 | 1275527889 - CANDLER HOSPITAL INCORPORATED | 580593388 - CANDLER HOSPITAL INCORPORATED | GA | General Acute Care Hospital (282N00000X) |
United | C5277 | $1265.00 | 1962403865 - DEKALB MEDICAL CENTER, INC., EMORY HILLANDALE HOSPITAL | 581966795 - (GA) EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | C5277 | $1265.00 | 1679664395 - SAINT JOSEPHS HOSPITAL OF ATLANTA INC | 580566257 - (GA) SAINT JOSEPHS HOSPITAL OF ATLANTA INC | GA | General Acute Care Hospital (282N00000X) |
United | C5277 | $699.00 | 1396770004 - HOSPITAL AUTHORITY OF WASHINGTON COUNTY, WASHINGTON COUNTY REGIONAL MEDICAL CENTER | 586012329 - (GA) HOSPITAL AUTHORITY OF WASHINGTON COUNTY | GA | Rural Acute Care Hospital (282NR1301X) |
United | C5277 | $1488.00 | 1861551327 - EMORY UNIVERSITY | 580566256 - (GA) EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | C5277 | $163.00 | 1861458507 - BRASS PARTNERSHIP IN COMMENDAM | 721097827 - (LA) BRASS PARTNERSHIP IN COMMENDAM | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5277 | $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 | C5277 | $1305.00 | 1104819366 - CHILDREN'S HOSPITAL | 720467503 - CHILDRENS HOSPITAL INC | LA | Children's Hospital (282NC2000X) |
United | C5277 | $210.00 | 1548233794 - METAIRIE OPHTHALMOLOGY ASC LLC, AMBULATORY EYE SURGERY CENTER OF LOUISIANA | 621822003 - (LA) THE METAIRIE OPHTHALMOLOGY ASC, LLC DBA AMBULATORY EYE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5277 | $225.00 | 1871235770 - SPINE CENTER OF EXCELLENCE LLC, SPINE CENTER OF EXCELLENCE | 861734777 - (LA) SPINE CENTER OF EXCELLENCE LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C5277 | $187.00 | 1245617562 - KAPLAN GENERAL HOSPITAL, INC. | 472540179 - (LA) KAPLAN GENERAL HOSPITAL INC | LA | Critical Access Hospital (282NC0060X) |
United | C5277 | $187.00 | 1447377767 - HOSPITAL SERVICE DISTRICT NO. 1 OF THE PARISH OF VERMILION, ABROM KAPLAN MEMORIAL HOSPITAL | 472540179 - (LA) KAPLAN GENERAL HOSPITAL INC | LA | Critical Access Hospital (282NC0060X) |
United | C5277 | $707.00 | 1881665164 - CLHG-LEESVILLE, BYRD REGIONAL HOSPITAL | 824337635 | LA | 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 C5277 vs. Other Skin Substitute Graft Application Codes
The HCPCS C5277 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 C5277 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 |
|---|---|---|
| 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) |
| C5277-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 greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children |
| C5278-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 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 C5277. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C5277 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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