Outpatient Prospective Payment System (hospital outpatient)
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 (list separately in addition to code for primary procedure)
HCPCS code C5278 is used on U.S. medical bills for outpatient prospective payment system (hospital outpatient): 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).
- Typical setting: Hospital outpatient
- National avg charge (illustrative): OPPS payments — review the Medicare APC weight if you are on Medicare.
- Most-disputed reason: Unbundling
What it means
What C5278 actually means
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).
The official CMS HCPCS Level II descriptor for this code is shown above. If the description on your bill does not match the service you actually received, that is a reason to ask for the itemized bill and dispute the line.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Quantity or units of service that exceed what the medical record supports.
- Duplicate billing on the same date of service.
- Missing or incorrect modifier (e.g., JW for drug waste, RT/LT for sides).
- Unbundling without supporting documentation.
If you see C5278 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on C5278 often also see these adjacent codes on the same bill.
HCPCS
C1062 — Intravertebral body fracture augmentation with implant (e.g., metal, polymer)
Intravertebral fx aug impl
HCPCS
C1300 — Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval
Hyperbaric oxygen
HCPCS
C1600 — Catheter, transluminal intravascular lesion preparation device, bladed, sheathed (insertable)
Cath, bladed, vasc prep
HCPCS
C1601 — Endoscope, single-use (i.e. disposable), pulmonary, imaging/illumination device (insertable)
Endo, single, pulmonary
HCPCS
C1602 — Orthopedic/device/drug matrix/absorbable bone void filler, antimicrobial-eluting (implantable)
Orth/matrx/bn fill drug-elut
Related BillBusted guides
Plain-English reads if you see C5278 on a bill.
C5278 FAQ
Plain-English answers.
What is C5278 used for on a medical bill?
HCPCS code C5278 is used on medical bills for outpatient prospective payment system (hospital outpatient): 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). Up to 49% of medical bills contain at least one error (CFPB, 2023), and codes in this category most often get flagged for unbundling. If you see C5278 on your bill, request the itemized statement and compare the units, date of service, and description to your Explanation of Benefits before paying.
How much should C5278 cost?
How much C5278 should cost depends on your payer and region. Up to 49% of medical bills contain at least one error (CFPB, 2023), and pricing for this HCPCS code is set by Medicare fee schedules for Medicare claims and by negotiated allowed amounts for commercial plans. Check the Medicare fee-schedule lookup tool, your insurer's member portal, or run a free BillBusted scan to compare your charge against typical allowed amounts.
Can I dispute a C5278 charge on my medical bill?
Yes, you can dispute a C5278 charge on your medical bill if the units, modifier, date of service, or coverage doesn't match the medical record or your insurance benefits. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024). Request the itemized bill, compare to your EOB, and use BillBusted's Resolution Pack to draft the dispute letter if needed.
Don't pay C5278 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.