There is no single amniotic membrane CPT code. For wounds, the application is reported with skin substitute graft codes 15271–15278, chosen by anatomic site and total treated area; on the eye, placement is reported with 65778 (without sutures), 65779 (single layer, sutured), or 65780 (multi-layer ocular surface reconstruction). The amniotic membrane product itself is billed separately with its own HCPCS Level II code where payable — coding guidance below follows CMS billing articles A57680 and A53441 and the CY2026 Physician Fee Schedule policies.
Amniotic Membrane CPT Codes for Wounds (15271–15278)
CMS billing guidance for skin substitute graft applications (Billing & Coding Article A57680) describes these codes as reporting the application of skin substitute grafts — which include amniotic membrane allografts — split by anatomic site group and treated wound surface area. The site groups are: trunk, arms, and legs in the first group; face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and digits in the second. Area bands are the first 25 cm² plus each additional 25 cm², or the first 100 cm² plus each additional 100 cm² for larger wounds. Descriptors below are paraphrased; the AMA-copyrighted CPT text governs.
| Code | Site group | Treated area band |
|---|---|---|
| CPT 15271 | Trunk, arms, legs | First 25 cm² |
| CPT 15272 | Trunk, arms, legs | Each additional 25 cm² (add-on) |
| CPT 15273 | Trunk, arms, legs | First 100 cm² |
| CPT 15274 | Trunk, arms, legs | Each additional 100 cm² (add-on) |
| CPT 15275 | Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, digits | First 25 cm² |
| CPT 15276 | Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, digits | Each additional 25 cm² (add-on) |
| CPT 15277 | Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, digits | First 100 cm² |
| CPT 15278 | Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, digits | Each additional 100 cm² (add-on) |
Worked area examples
- 18 cm² venous leg ulcer: total treated area is within the first 25 cm² band, so report 15271 alone (no add-on).
- 60 cm² leg wound: report 15271 for the first 25 cm² plus two units of 15272 for the additional 35 cm² (each additional 25 cm² or part thereof).
- 30 cm² diabetic foot ulcer: feet are in the second site group, so report 15275 for the first 25 cm² plus one unit of 15276 for the additional 5 cm².
Measure the total treated wound surface area after debridement, and sum areas across wounds in the same site group. Per A57680, the units of product billed must be accounted for in the medical record, including any discarded amount and the reason for it; removal of the prior graft and simple cleansing are included in the application codes and are not reported separately.
Amniotic Membrane CPT Codes for the Eye (65778, 65779, 65780)
Ocular amniotic membrane placement uses a different code family entirely. Per Medicare NCCI Policy Manual Chapter 12 and CMS Billing & Coding Article A53441:
- 65778 — placement of amniotic membrane on the ocular surface without the use of sutures. This is the code most commonly used for sutureless placement.
- 65779 — placement of amniotic membrane on the ocular surface as a single layer, with sutures.
- 65780 — ocular surface reconstruction with amniotic membrane transplantation, multiple layers.
The HCPCS code V2790 (amniotic membrane for surgical reconstruction, per procedure) is included in 65778 and 65779 and is not separately billable with them. Medicare makes V2790 separately reimbursable only with 65780 in the office (non-facility) setting, with an invoice submitted. Ocular coding is a narrow slice of amniotic membrane use; verify payer-specific edits before reporting.
How to Choose Between 15271 and 15275 (and When to Use the Add-on Codes)
Two facts drive code selection: the anatomic site group and the total treated area.
- Site group: leg and trunk wounds code from 15271–15274; foot, hand, and face wounds code from 15275–15278. A foot ulcer therefore takes 15275/15276, not 15271/15272, even though the area arithmetic is identical.
- Total area across wounds in the same site group: if two leg wounds totaling 40 cm² are grafted in one session, report 15271 plus 15272 ×1 — the areas combine within the group, not per wound.
- Add-on logic: 15272/15276 cover each additional 25 cm² or part thereof; 15273/15277 (first 100 cm²) and 15274/15278 (each additional 100 cm²) replace that arithmetic for larger wounds. Add-on codes are never reported without their primary code.
CPT vs HCPCS vs ICD-10-CM for Amniotic Membrane Claims
The most common coding failure is treating product and procedure coding as interchangeable. CPT application codes report the clinician's work of applying a skin substitute to a defined wound area and body site. HCPCS product codes identify the biologic material and its units. ICD-10-CM codes justify the diagnosis and ulcer characteristics.
| Code Type | What It Communicates | Documentation Needed |
|---|---|---|
| CPT 15271–15278 (wounds) · 65778–65780 (eye) | Application site and treated area — the procedure only, not the product. | Anatomic location, total treated area, procedure details, and whether add-on area codes are supported. |
| HCPCS product code (e.g., Q4250) | Specific allograft product and units, commonly per square centimeter. | Product name, size, units applied, lot information, expiration, and payer-required wastage documentation. Full table in the HCPCS reference. |
| ICD-10-CM | Ulcer etiology, site, laterality, severity, and comorbid disease. | DFU or VLU diagnosis, non-pressure ulcer depth code, infection or ischemia status, and relevant comorbidities. |
Documentation That Supports the CPT Line
Strong documentation starts before the first graft. For DFUs, record ulcer duration, diabetes control factors, neuropathy status, offloading plan, vascular assessment, infection evaluation, debridement, depth, tissue type, drainage, undermining, exposed structures, and serial measurements. For VLUs, document compression use, edema control, venous history, arterial sufficiency when relevant, and failure to progress despite appropriate conservative therapy.
At the application visit, the note should include pre- and post-debridement measurements when performed, wound surface area calculation, product size opened, product area applied, any discarded amount if required by payer policy, fixation method, secondary dressing, offloading or compression instructions, and planned reassessment. The clinical note, charge ticket, inventory log, and product lot record should tell the same story. If the wound is not improving after several applications, reassess perfusion, infection, pressure, edema, nutrition, adherence, and diagnosis before continuing.
2026 Medicare Context in Brief
For 2026, CMS pays skin substitute products as incident-to supplies when furnished with a covered application procedure under the Physician Fee Schedule (non-facility setting), with products unpackaged and paid under the hospital outpatient prospective payment system in HOPD settings. The multi-MAC skin substitute LCDs for DFUs and VLUs were withdrawn before their scheduled January 1, 2026 implementation, so coverage analysis remains patient-, wound-, and MAC-specific. Product-specific payment rates and HCPCS details live in the CMS skin substitute reimbursement guide and the HCPCS coding reference; this page intentionally does not restate rates.
Questions About Coding an Amniotic Membrane Case?
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Contact the NextGen teamReferences
- Centers for Medicare & Medicaid Services. Billing and Coding: Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities (A57680). Medicare Coverage Database. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57680
- Centers for Medicare & Medicaid Services. Billing and Coding: Amniotic Membrane Billing Guidelines for HCPCS Code V2790 (A53441). Medicare Coverage Database. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=53441
- Centers for Medicare & Medicaid Services. Medicare National Correct Coding Initiative Policy Manual for Medicare Services, Chapter 12. https://www.cms.gov/files/document/12-chapter12-ncci-medicare-policy-manual-2026-final.pdf
- Centers for Medicare & Medicaid Services. Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F). Published October 31, 2025. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f
- Centers for Medicare & Medicaid Services. Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Correction. 90 FR 54589; November 28, 2025 (FR Doc. 2025-21458). https://www.federalregister.gov/documents/2025/11/28/2025-21458/
- Centers for Medicare & Medicaid Services. Final Local Coverage Determinations (LCDs) for Certain Skin Substitutes Withdrawn. Updated December 24, 2025. https://www.cms.gov/newsroom/fact-sheets/upcoming-update-final-local-coverage-determinations-lcds-certain-skin-substitutes
- Centers for Medicare & Medicaid Services. 2020 HCPCS Application Summary, Biannual 2, Drugs and Biologicals. Final decision establishing Q4250 for AmnioAMP-MP. https://www.cms.gov/files/document/2020-hcpcs-application-summary-quarter-2-2020-drugs-and-biologicals-updated-07312020.pdf