Chargemaster Template for Hospital Outpatient Wound Care Services

Last updated on 2/18/23 | First published on 5/5/22 | Literature review current through Feb. 2023 [cite]

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This table illustrates common wound care services and procedures performed at hospital outpatient settings, and refers to Centers for Medicare & Medicaid Services (CMS) facility fees.[1] For the Medicare Physician Fee Schedule, see topic "HCPCS/CPT Codes Commonly Utilized in Wound Care and HBOT".

Instructions for the interactive Tool below: 1. Select number of entries (rows) to be displayed on the table. 2. Use the "Search" field to find a specific code or description. For educational purposes only. Your hospital chargemaster, Medicare Administrative Contractor (MAC) and Coverage Determinations should serve as the definite source of billing guidelines.

 Printable Table: Chargemaster Template for Wound Care Services

Type	HCPCS/ CPT	Description	CMS Status Indicator	Revenue Code	CY 2023 CMS Payment (Unadjusted for hospital wage index)	CY 2023 Hospital Minimum Unadjusted Copayment
Outpatient Visits - New Patients	99202	Office / Outpatient Visit - New Patient - Straightforward Medical Decision Making, 15-29 min	B	510 / 761
Outpatient Visits - New Patients	99203	Office / Outpatient Visit - New Patient - Low Medical Decision Making, 30-44 min	B	510 / 761
Outpatient Visits - New Patients	99204	Office / Outpatient Visit - New Patient - New Moderate Medical Decision Making, 45-59 min	B	510 / 761
Outpatient Visits - New Patients	99205	Office / Outpatient Visit - New Patient - High Medical Decision Making, 60-74 min	B	510 / 761
Outpatient Visits - Established Patients	99211	Office / Outpatient Visit - Established Patient - May not require phys/QHP	B	510 / 761
Outpatient Visits - Established Patients	99212	Office / Outpatient Visit - Established Patient - Straigthforward Medical Decision Making, 10-19 min	B	510 / 761
Outpatient Visits - Established Patients	99213	Office / Outpatient Visit - Established Patient - Low Medical Decision Making, 20-29 min	B	510 / 761
Outpatient Visits - Established Patients	99214	Office / Outpatient Visit - Established Patient - Moderate Medical Decision Making, 30-39 min	B	510 / 761
Outpatient Visits - Established Patients	99215	Office / Outpatient Visit - Established Patient - High Medical Decision Making, 40-54 min	B	510 / 761
Outpatient Visits	G0463	Hospital OP Clinic Visit - MEDICARE ONLY (for Hospital Outpatient Departments)	J2	510 / 761	$ 120.86	$ 24.18
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	15271	Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area (HIGH)	T	510 / 761	$ 1,725.86	$ 345.18
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	15272	Application of 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 (HIGH)	N	510 / 761
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	15273	Application of 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 (HIGH)	T	510 / 761	$ 3,253.04	$ 650.61
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	15274	Application of 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 (HIGH)	N	510 / 761
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	15275	Application of 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 (HIGH)	T	510 / 761	$ 1,725.86	$ 345.18
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	15276	Application of 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 (HIGH)	N	510 / 761
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	15277	Application of 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 (HIGH)	T	510 / 761	$ 1,725.86	$ 345.18
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	15278	Application of 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 (HIGH)	N	510 / 761
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	C5271	Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area - (LOW, MEDICARE ONLY)	T	510 / 761	$ 580.95	$ 116.19
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	C5272	Application of low cost skin substitute graft )	N	510 / 761
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	C5273	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 - (LOW, MEDICARE ONLY)	T	510 / 761	$ 1,725.86	$ 345.18
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	C5274	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 - (LOW, MEDICARE ONLY)	N	510 / 761
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	C5275	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 - (LOW, MEDICARE ONLY)	T	510 / 761	$ 580.95	$ 116.19
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	C5276	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 - (LOW, MEDICARE ONLY)	N	510 / 761
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	C5277	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 - (LOW, MEDICARE ONLY)	T	510 / 761	$ 580.95	$ 116.19
Application of Cellular and/or Tissue Based Products (Skin Substitutes)	C5278	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 - (LOW, MEDICARE ONLY)	N	510 / 761
Skin Substitutes (Product)	Q4101	Skin substitute, APLIGRAF®, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4102	Skin substitute, OASIS® WOUND MATRIX, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4103	Skin substitute, OASIS® BURN MATRIX, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4104	Skin substitute, INTEGRA BILAYER MATRIX WOUND DRESSING, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4105	Skin substitute, INTEGRA DERMAL REGENERATION TEMPLATE (DRT), per 1 sq cm	N	636
Skin Substitutes (Product)	Q4106	Skin substitute, DERMAGRAFT®, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4107	Skin substitute, GRAFTJACKET, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4108	Skin substitute, INTEGRA MATRIX, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4110	Skin substitute, PRIMATRIX, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4116	Skin substitute, ALLODERM, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4118	Skin substitute, MATRISTEM MICRO MATRIX, per 1 sq cm - Non Medicare only	N	636
Skin Substitutes (Product)	Q4121	Skin substitute, THERASKIN, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4124	Skin substitute, OASIS® ULTRA TRI LAYER WOUND MATRIX, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4186	Skin substitute, EPIFIX, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4133	Skin substitute, GRAFIX PRIME, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4195	Skin substitute, PURAPLY, per 1 sq cm	N	636
Skin Substitutes (Product)	Q4196	Skin substitute, PURAPLY AM, per 1 sq cm	N	636
Biopsy	11102	Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette) single lesion	T	510 / 761	$ 180.58	$ 36.12
Biopsy	11103	Tangential biopsy of skin each separate/additional lesion	N	510 / 761
Biopsy	11104	Punch biopsy of skin (including simple closure, when performed) single lesion	T	510 / 761	$ 373.07	$ 74.62
Biopsy	11105	Punch biopsy of skin each separate/additional lesion	N	510 / 761
Biopsy	11106	Incisional biopsy of skin (e.g., wedge) (including simple closure, when performed) single lesion	T	510 / 761	$ 580.95	$ 116.19
Biopsy	11107	Incisional biopsy of skin each separate/additional lesion	N	510 / 761
Burn	16020	Dressing an/or debmt partial thn burn, initial or subsequent, small	Q1	510 / 761	$ 180.58	$ 36.12
Burn	16025	Dressing an/or debmt partial thn burn, initial or subsequent, med	T	510 / 761	$ 180.58	$ 36.12
Burn	16030	Dressing an/or debmt partial thn burn, initial or subsequent, lg	T	510 / 761	$ 373.07	$ 74.62
Chemical Cauterization	17250	Chemical cauterization of granulation tissue (proud flesh) - - not to be used with excision codes for same lesion	Q1	510 / 761	$ 180.58	$ 36.12
Debridement	97597	Debridement, Open Wound first 20 sq cm or less	T	510 / 761	$ 180.58	$ 36.12
Debridement	97598	Debridement, Open Wound each additional 20 sq cm, or part thereof	N	510 / 761
Debridement	11042	Debridement: Subcutaneous tissue - first 20 sq cm or less	T	510 / 761	$ 373.07	$ 74.62
Debridement	11043	Debridement: Muscle / Fascia - first 20 sq cm or less	T	510 / 761	$ 580.95	$ 116.19
Debridement	11044	Debridement: Bone - first 20 sq cm or less	J1	510 / 761	$ 1,499.55	$ 299.91
Debridement	11045	Debridement, Subcutaneous tissue, Each Addt'l 20 sq cm or Part Thereof	N	510 / 761
Debridement	11046	Debridement, Muscle/Fascia, Each Addt'l 20 sq cm or Part Thereof	N	510 / 761
Debridement	11047	Debridement, Bone, Each Addt'l 20 sq cm or Part Thereof	N	510 / 761
Debridement (Non Selective) and NPWT	97602	Removal of devitalized tissue from wound(s); non-selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, & instruction(s) for ongoing care, per session	Q1	510 / 761	$ 180.58	$ 36.12
Debridement (Non Selective) and NPWT	97605	Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters	Q1	510 / 761	$ 180.58	$ 36.12
Debridement (Non Selective) and NPWT	97606	Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters	Q1	510 / 761	$ 373.07	$ 74.62
Debridement (Non Selective) and NPWT	97607	Negative Pressure Wound Therapy (disposable) < 50 sq cm	T	510 / 761	$ 373.07	$ 74.62
Debridement (Non Selective) and NPWT	97608	Negative Pressure Wound Therapy (disposable) > 50 sq cm	T	510 / 761	$ 373.07	$ 74.62
Hyperbaric Oxygen Therapy	G0277	Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval - per 30 min (Medicare hospital outpatient only)	S	413	$ 125.07	$ 25.02
Hyperbaric Oxygen Therapy	99183	Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session - per session	B	413
HBOT Related Procedures	96372	Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Q1	510 / 761	$ 67.47	$ 13.50
HBOT Related Procedures	82962	Glucose, blood by glucose monitoring device(s) - - Glucometer (reimbursement dependent upon state reimbursement)	Q4	300
HBOT Related Procedures	69209	Removal impacted cerumen requiring lavage/irrigation, unilateral	Q1	510 / 761	$ 57.48	$ 11.50
HBOT Related Procedures	69210	Removal impacted cerumen requiring instrumentation, unilateral	Q1	510 / 761	$ 57.48	$ 11.50
Incision and Drainage	10060	Incision & drainage of abscess (carbuncle, suppurative hidradenitis, cyst, cutaneous or subcutaneous abscess, furuncle, or paronychia): simple / single	T	510 / 761	$ 180.58	$ 36.12
Incision and Drainage	10061	Incision & drainage of abscess: complicated / multiple	T	510 / 761	$ 373.07	$ 74.62
Nails	11719	Trimming of nondystrophic nails, any number	Q1	510 / 761	$ 57.48	$ 11.50
Nails	11720	Debridement of nail(s) by any method(s): 1 - 5 nails	Q1	510 / 761	$ 57.48	$ 11.50
Nails	11721	Debridement of nail(s) by any method(s): 6 or more nails	Q1	510 / 761	$ 57.48	$ 11.50
Nails	11730	Avulsion of nail plate, partial or complete, simple: 1 nail plate	Q1	510 / 761	$ 180.58	$ 36.12
Nails	11732	Avulsion of nail plate; each additional nail plate (list separately in addition to code for primary procedure)	N	510 / 761
Nails	11750	Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal	T	510 / 761	$ 373.07	$ 74.62
Paring or Cutting	11055	Paring or cutting of benign hyperkeratotic lesion (Corn or callus): 1 lesion	Q1	510 / 761	$ 180.58	$ 36.12
Paring or Cutting	11056	Paring or cutting of benign hyperkeratotic lesion: 2 - 4 lesions	Q1	510 / 761	$ 180.58	$ 36.12
Paring or Cutting	11057	Paring or cutting of benign hyperkeratotic lesion: more than 4 lesions	T	510 / 761	$ 180.58	$ 36.12
Strapping / Compression Bandages	29445	Application of rigid total contact leg cast	T	510 / 761	$ 239.91	$ 47.99
Strapping / Compression Bandages	29580	Application of unna boot	T	510 / 761	$ 145.76	$ 29.16
Strapping / Compression Bandages	29580-50	Application of Bilateral unna boot	T	510 / 761	$ 218.64	$ 43.74
Strapping / Compression Bandages	29581	Application of multi-layer venous wound compression system, below knee	T	510 / 761	$ 145.76	$ 29.16
Strapping / Compression Bandages	29581-50	Application of Bilateral multi-layer venous wound compression system, below knee	T	510 / 761	$ 218.64	$ 43.74
Veins and Related Diagnostic Tests	36478	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated	J1	510 / 761	$ 2,978.97	$ 595.80
Veins and Related Diagnostic Tests	36479	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; second and subsequent vein(s) veinstreated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)	N	510 / 761
Veins and Related Diagnostic Tests	36465	Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein)	T	510 / 761	$ 1,725.86	$ 345.18
Veins and Related Diagnostic Tests	36466	Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg	T	510 / 761	$ 1,725.86	$ 345.18
Veins and Related Diagnostic Tests	93970	Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study	S	761 / 921 402	$ 233.52	$ 46.71
Veins and Related Diagnostic Tests	93971	Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study	S	761 / 921 402	$ 106.88	$ 21.38
Venous/Arterial Studies (Extremities)	93922	Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels)	Q1	921	$ 116.11	$ 23.23
Venous/Arterial Studies (Extremities)	93922-52	Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels); report modifier 52 for a unilateral study when recording 1-2 levels.	Q1	921	$ 58.06	$ 11.62
Venous/Arterial Studies (Extremities)	93923	Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more level(s), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia);	S	921	$ 145.43	$ 29.09
Additional Procedure Codes	10080	Incision and drainage of pilonidal cyst; simple	T	510 / 761	$ 648.97	$ 129.80
Additional Procedure Codes	10081	Incision and drainage of pilonidal cyst; complicated	T	510 / 761	$ 648.97	$ 129.80
Additional Procedure Codes	10120	Incision and removal or foreign body, subcutaneous tissues; simple	T	510 / 761	$ 373.07	$ 74.62
Additional Procedure Codes	10121	Incision and removal or foreign body, subcutaneous tissues; complicated	J1	510 / 761	$ 1,499.55	$ 299.91
Additional Procedure Codes	10140	Incision and drainage of hematoma, seroma or fluid collection	J1	510 / 761	$ 1,499.55	$ 299.91
Additional Procedure Codes	10160	Puncture aspiration of abscess, hematoma, bulla, or cyst	T	510 / 761	$ 373.07	$ 74.62
Additional Procedure Codes	10180	Incision and drainage, complex, post-op wound infection	J1	510 / 761	$ 2,583.25	$ 516.65
Additional Procedure Codes	15110	Epidermal autograft, trunk, arms, legs; first 100 sq cm or less	T	510 / 761	$ 1,725.86	$ 345.18
Additional Procedure Codes	15111	Epidermal autograft, trunk, arms, legs; each additional 100 sq cm or less or part thereof	N	510 / 761
Additional Procedure Codes	15115	Epidermal autograft, face scalp, eyelids, mouth, neck, ears, orbits, gentialia, hands, feet, and/or multiple digits; first 100 sq cm or less	T	510 / 761	$ 1,725.86	$ 345.18
Additional Procedure Codes	15116	Epidermal autograft, face scalp, eyelids, mouth, neck, ears, orbits, gentialia, hands, feet, and/or multiple digits; each additional 100 sq cm or part thereof	N	510 / 761

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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

REFERENCES

CMS. CMS Hospital Outpatient PPS Addendum A and Addendum B Updates . 2021;.

Topic 1742 Version 23.1

Chargemaster Template for Hospital Outpatient Wound Care Services

Chargemaster Template for Hospital Outpatient Wound Care Services

REFERENCES

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