Contribution of health care factors to the burden of skin disease in the United States

FROM

THE ACADEMY

Contribution of health care factors to the burden of skin disease in the United States Henry W. Lim, MD,a Scott A. B. Collins, MD,b Jack S. Resneck, Jr, MD,c Jean L. Bolognia, MD,d Julie A. Hodge, MD, MPH,e Thomas A. Rohrer, MD,f Marta J. Van Beek, MD, MPH,g David J. Margolis, MD, PhD,h Arthur J. Sober, MD,i Martin A. Weinstock, MD, PhD,j David R. Nerenz, PhD,k Wendy Smith Begolka, MBS,l and Jose V. Moyano, PhDl Detroit, Michigan; Tigard, Oregon; San Francisco, California; New Haven, Connecticut; Fullerton, California; Boston, Massachusetts; Iowa City, Iowa; Philadelphia, Pennsylvania; Providence, Rhode Island; and Schaumburg, Illinois The American Academy of Dermatology has developed an up-to-date national Burden of Skin Disease Report on the impact of skin disease on patients and on the US population. In this second of 3 manuscripts, data are presented on specific health care dimensions that contribute to the overall burden of skin disease. Through the use of data derived from medical claims in 2013 for 24 skin disease categories, these results indicate that skin disease health care is delivered most frequently to the aging US population, who are afflicted with more skin diseases than other age groups. Furthermore, the overall cost of skin disease is highest within the commercially insured population, and skin disease treatment primarily occurs in the outpatient setting. Dermatologists provided approximately 30% of office visit care and performed nearly 50% of cutaneous surgeries. These findings serve as a critical foundation for future discussions on the clinical importance of skin disease and the value of dermatologic care across the population. ( J Am Acad Dermatol http://dx.doi.org/10.1016/j.jaad.2017.03.006.) Key words: burden of skin disease; burden of skin disease report; claims-based prevalence; dermatology; direct cost; economic driver; health care economics; indirect cost; inpatient cost; insurer cost; medical cost; office visit cost; outpatient cost; over-the-counter drug cost; prescription drug cost; skin health care provider; surgery; workforce.

S

kin disease affects millions of people worldwide and is a leading cause of global disease burden.1 The past decade has brought therapeutic innovations to medicine but also many changes to the delivery of health care.2-4 With finite resources available for research, clinical care, and public health initiatives, it is imperative to accurately quantify the overall burden of skin disease for the US population.

From the Department of Dermatology, Henry Ford Hospital, Detroit, Michigana; Dermatology Associates PC, Tigard, Oregonb; the Department of Dermatology and Institute for Health Policy Studies, University of California at San Francisco, San Francisco, Californiac; the Department of Dermatology, Yale School of Medicine, New Haven, Connecticutd; private practice, Fullerton, Californiae; SkinCarePhysicians, Boston, Massachusettsf; the Department of Dermatology, University of Iowa, Iowa City, Iowag; the Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvaniah; the Department of Dermatology, Massachusetts General Hospital, Boston, Massachusettsi; the Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Islandj; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit,

Abbreviations used: AAD: BSD:

American Academy of Dermatology burden of skin disease

The last national Burden of Skin Disease (BSD) Report was published over 10 years ago.5 The American Academy of Dermatology (AAD) has

Michigank; and the Department of Science, Quality and Practice, American Academy of Dermatology, Schaumburg, Illinois.l Funding sources: None. Conflict of interest: None declared. Accepted for publication March 13, 2017. Reprint requests: Jose V. Moyano, PhD, American Academy of Dermatology, 930 East Woodfield Road, Schaumburg, IL 60173. E-mail: [email protected]. Published online April 17, 2017. 0190-9622/$36.00 Ó 2017 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2017.03.006

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developed an up-to-date BSD Report to provide a US population by age and insurance status comprehensive assessment of the prevalence and Medical Expenditure Panel Survey data were used economic burden of 24 skin disease categories to estimate the US 2013 population by age and through the use of 2013 medical claims data insurance status. Specifically, the participants’ pritabulation.6 This report estimates that 85 million mary payer as of July 1, 2013, was used, resulting in Americans were seen by a physician for at least 1 assignment to 1 of 4 insurance statuses: commercial, skin disease in 2013. This led to an associated Medicare, Medicaid, and uninsured. The following direct health care cost of databases were used for the nearly $75 billion and redevelopment of 2013 prevaCAPSULE SUMMARY sulted in $11 billion in lost lence and cost estimates: productivity.7 In this second commercial (Truven Health The prevalence of most skin diseases Analytics MarketScan Comof 3 manuscripts, these data increases with age; prevalence is highest mercial Database [Markethave been further analyzed among Medicare patients, nearly half of Scan]), Medicare (Medicare related to patient age, skin whom have skin disease. 5% sample and Milliman disease, insurance status, The direct and per-person costs for the Medicare Part D Claims and other health care fac24 skin disease categories studied here Database [Milliman PDCD]), tors. These data yield vary by disease and by insurer and are Medicaid (Kaiser Family further insights to inform often higher for those with commercial Foundation report), and discussions on dermatoinsurance. uninsured (Kaiser Family logic health care access, Foundation report).8,9 As treatment selection, care coDermatologists provide the majority of ordination, and policy described in the first manucare for serious and chronic skin decisions. script, a set of data selection diseases, including skin cancer, psoriasis, rules for each data source acne, rosacea, and vitiligo. was established to ensure representative and quality METHODS data.7 In 2014, the AAD apd

d

d

pointed a BSD Work Group* to develop a current BSD report. Milliman (New York, NY) was selected to work with the BSD Work Group. Detailed methodology can be found in the AAD BSD Report.6 US population data and prevalence measurement methodology, identification and categorization of skin diseases, and definitions of health care cost categories have been described in detail in the first manuscript of this series.7 They are briefly summarized below.

Skin disease category classification Twenty-four skin disease categories were identified for inclusion in this report and were assigned corresponding skin-related 2013 International Classification of Disease, Ninth Edition, diagnosis codes. The identification and assignment of skin conditions and International Classification of Disease, Ninth Edition, codes followed a set of key principles. *Chair: Henry W. Lim, MD; Members: Jean Bolognia, MD, Scott A. B. Collins, MD, Julie A. Hodge, MD, David J. Margolis, MD, PhD, Jack S. Resneck, MD, Thomas A. Rohrer, MD, Arthur J. Sober, MD, Marta J. Van Beek, MD, MPH, and Martin A. Weinstock, MD, PhD; Consultant: David R. Nerenz, PhD; Staff: Wendy Smith Begolka, MBS, and Jose V. Moyano, PhD

Prevalence measurement methodology Prevalence in this report refers to the portion of the population having at least 1 of the 24 skin disease categories recorded on a health insurance claim during 2013. A skin disease diagnosis during 2013 may reflect both newly diagnosed skin disease and chronic skin disease requiring ongoing treatment. Prevalence, therefore, excludes people with a skin disease who did not file insurance claims in 2013, regardless of reason. To estimate the number of individuals diagnosed with skin disease in 2013, the specific prevalence for each skin disease category was converted to the number of individuals on the basis of the total population for each insured status. The prevalence for a specific skin disease category was compared on the basis of age groups by averaging the relative prevalence ratio between successive age groups. Medical cost tabulation and dimensions Medical costs associated with skin disease were determined through the use of diagnosis codes, procedure codes, national drug codes, and physician specialty codes to identify skin diseaseeassociated claims. When a claim had diagnoses for skin and nonskin diseases, costs were divided among the conditions such that only the skin disease portion

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was included in tabulations. Claims data were tabulated as inpatient, outpatient therapies, outpatient surgeries/procedures, other dermatology procedures, and office visits. The complete list of surgical procedures included in the analysis is provided in Supplemental Table I (available at http:// www.jaad.org).6 On the basis of established Current Procedural Terminology categories, phototherapy, photochemotherapy, photodynamic therapy, and targeted phototherapy were not considered surgery and therefore not included in the analysis. Whereas the classification used was appropriate to provide a consistent approach across all skin diseases, it is not intended to represent a standard with regard to defining codes as ‘‘surgeries/procedures’’ versus ‘‘other’’ for payment policy or legislative purposes. For the uninsured population, commercial tabulated costs were used and the uninsured-to-commercial cost ratio by type of service was applied. Services and costs for the 24 skin disease categories were assigned to the first skin diagnosis on the claim. To calculate the cost per individual with diagnosed skin disease, the total cost for each skin disease was divided by the number of individuals diagnosed with the skin disease. This calculation was performed for the total population and by insurance status. Note that 1 individual may have more than 1 diagnosed skin disease. Prescription drug tabulation dimensions Through the use of the claims datasets, prescription drug claims in 1 (or more) of the following categories were identified: d ‘‘Dermatological’’ drugs (as classified by the MediSpan Therapeutic Classification System): drugs that are nearly always used for skin conditions d Skin disease vaccines d The top 100 drugs most frequently prescribed by dermatologists (as defined by the 2013 Medicare Part D Prescriber Public Use Files) Costs were tabulated by means of insurance status, type of drug, and specialty status.

RESULTS Impact of age and insurance status on skin disease diagnosis The demographics of each insured population has been shown previously,7 with Medicaid predominantly patients age 0 to 17 years and Medicare patients predominantly age $65 years. The prevalence of skin disease was highest among patients with Medicare (47.8%) compared with those who had commercial insurance (22.5%), were on Medicaid (24.6%), and were uninsured (23.6%)

(Fig 1, A). Patients with Medicaid had a higher prevalence of wounds and burns, contact dermatitis, and cutaneous infections relative to all other skin diseases (Fig 1, B). Several conditions were most prevalent in the Medicare population, including noncancerous skin growths,y viral/fungal diseases, actinic damage, and cutaneous infections. Furthermore, the Medicare population also had a high probability of a concurrent skin disease diagnosis (Fig 1, C ). The prevalence of skin disease generally increased with age. Sixteen of the 24 skin diseases had a noted increase from age 0 to $65 years; these are grouped in ‘‘high’’ or ‘‘moderate increase’’ in Fig 2, A. Eight skin diseases had prevalence that was relatively constant for all age groups, with a notable and expected exception of acne, which showed a decrease. Nonmelanoma skin cancer, ulcers, and actinic damage had the highest relative change in prevalence over time, increasing by 4- to [14-fold with age (Fig 2, B). Direct medical cost of skin disease by insurer The medical cost for the 24 skin disease categories was nearly $46 billion in 2013.7 The medical cost for each skin disease varied widely, ranging from more than $8 billion for cutaneous lymphoma to $49 million for vitiligo (Fig 3). Total medical costs for the treatment of ulcers, cutaneous infections, and nonmelanoma skin cancer were highest in the Medicare population. Overall, the top 10 skin diseases, on the basis of medical cost, generally correlated with the most prevalent skin disease categories within each insurance status, with some exceptions (Fig 4). For example, melanoma and connective tissue diseases represent a combined prevalence of 0.48% in the commercial population, yet result in 7.3% ($1.4 billion) of the total medical cost for this group. For each insurance status, the 10 skin diseases with the highest economic burden accounted for [80% of the total medical cost in each group. Cost per person diagnosed with skin disease Across the total insured population, the skin diseases with the highest pereaffected person costs were cutaneous lymphoma ($2403 to $4517), ulcers ($1317 to $1979), melanoma ($991 to $1923), nonmelanoma skin cancer ($1154 to $1311), and connective tissue diseases ($952 to $1703) (Fig 5). y

This skin disease category is clinically broad in nature. In practice, these growths may be biopsied to rule out skin cancer or other underlying skin disease pathology. The final pathology results for some are benign (noncancerous).

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Fig 1. US population with skin disease by insurance status. A, The stacked column graph represents the relative percentage of the US population with skin disease (pink), compared to those without skin disease (gray) for each insurance status. The actual number of individuals (in thousands) is indicated inside the bar. B, The table lists the 24 skin disease categories in alphabetical order, and indicates the prevalence of population with a specific skin disease (in percentage) for each insurance status (commercial, Medicare, Medicaid, and uninsured). The colored cells indicate a ‘‘heat map’’ of prevalence, ranging from highest prevalence (dark red) to lowest prevalence (dark blue) for each insurance status. C, The bubble graphs plot the probability of a Medicare-insured individual diagnosed with melanoma, actinic damage, noncancerous skin growths, ulcers, or congenital abnormalities of having another skin disease. The relative probability is indicated by the size of the bubble, with the actual probability percentage in each label. The y axis plots the percentage prevalence of skin disease in the Medicare population and the center of each bubble corresponds to the disease-specific prevalence.

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Fig 2. Prevalence of skin disease across age groups. A, The table ranks the prevalence of the 24 skin diseases across the entire US population by relative change across age group. The ratio in prevalence change across the four age groups was calculated (determined by dividing the prevalence of [18-44y]/[0-17y], [45-64y]/[18-44y] and [65+y]/[45-64y]), and the average was used to define 3 arbitrary categories of change in prevalence by age, namely high increase ([2.32x; red zone of the ‘heat map’), moderate increase (1.28-2.32x; white zone), and null/irregular-tomoderate decrease (\1.28; blue zone). B, The line graphs represent the total percentage prevalence for the top 5 skin diseases with the highest increase in relative prevalence across the four age groups (0-17, 18-44, 45-64, and 651 years).

Fig 3. Relative medical costs of skin disease by insurance status. The histogram represents the relative percentage of disease-specific total medical cost by insurance status (commercial [blue], Medicare [orange], Medicaid [green], and uninsured [yellow]), and sorted by decreasing total medical cost. The actual medical costs per insurance status in USD millions is indicated in each bar.

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Fig 4. Direct medical costs and number of diagnosed individuals. The graphs plot the top 10 skin disease categories by direct medical cost (in USD millions; y axis) for commercial (A), Medicare (B), Medicaid (C), and uninsured (D) populations in 2013. The bubble size represents the relative prevalence for each of the indicated diseases. The label includes the skin disease analyzed, its total medical cost, and the actual number of diagnosed individuals. Note that the latter value may indicate more than one diagnosis per individual (overlapping); therefore, the sum of these values will exceed the number of insured individuals in the population.

for this group. Across the 24 skin disease categories, total aggregate medical costs for the commercially insured often exceeded those of the other insurance groups.

Fig 5. 2013 cost of skin disease per diagnosed person. The range bar graph represents the cost range across insurers per diagnosed person with skin disease in 2013 for the top 10 most costly skin diseases and ranked by their weighted average cost in USD (indicated by a white line).

For 21 of the 24 skin diseases, approximately 75% of the medical costs attributable to skin disease were for outpatient services, whereas 25% were for inpatient services (data not shown). The top 10 skin disease categories associated with high inpatient costs for each insurance status are shown in Fig 6. Accurate data for the uninsured population are lacking; therefore, no information can be presented

Top prescription drugs for skin disease by insurer The majority (82.5%) of total prescription drug costs for skin disease across insurance statuses were for nonspecialty drugs (typically nonbiologic, longestablished drugs),10 and 17.5% were for specialty drugs (typically biologic and/or injectable drugs)10 (Fig 7, A). Total prescription drug costs for skin disease was highest in the commercially insured population (Fig 7, A, upper panel); however, the pereMedicare-insured person cost for prescription drugsz was higher than for other insured populations (Fig 7, A, lower panel) because of a higher skin disease prevalence in this population. Prescriptions for 10 skin disease drugs accounted for approximately 40% of total prescription drug costs across all insurance statuses (Fig 7, B). These z

Skin vaccines may be billed as either a medical or a prescription drug benefit; when the costs for these benefits were added to the total per person cost, the final costs were $53.34 for commercially insured individuals, $79.53 for Medicare enrollees, and $26.15 for Medicaid participants.

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lymphoma were predominantly seen by dermatologists for all insurance statuses (Fig 8, C ). Furthermore, for Medicare patients and the commercially insured, actinic damage, acne, and nonmelanoma skin cancer were also among the top 10 skin disease categories seen by dermatologists.

DISCUSSION

Fig 6. Estimated insured impatient/outpatient cost per diagnosed person. The stacked column graphs represent the total percentage of cost per diagnosed (affected) person by outpatient (gray bars) and inpatient (black bars) services for commercial (upper panel), Medicare (middle panel), and Medicaid (lower panel) populations. The top 10 skin diseases ranked by total inpatient cost are shown. The actual cost in USD per diagnosed person for each type of service is indicated inside (outpatient) or right adjacent to (inpatient) the corresponding bars.

top 10 prescription drugs varied by insurance status but included drugs used primarily for the treatment of psoriasis, infections, acne, and rosacea.

Dermatologist provision of care for skin disease The percentage of office visits for skin disease with dermatologists was 35.4% for the commercially insured population, 42.6% for Medicare patients, and 17.4% for Medicaid recipients (Fig 8, A). The percentage of surgical procedures for skin disease performed by dermatologists was 53.7% for the commercially insured population, 53.0% for those on Medicare, and 31.5% for Medicaid patients (Fig 8, B). Vitiligo, psoriasis, rosacea, and cutaneous

In 2013, nearly 85 million Americans were diagnosed with and treated for skin disease.7 The economic burden to the US society is affected by the prevalence of specific skin diseases, patient age, and insurance status. These results indicate that skin disease is a lifelong health care concern and affects individuals of all ages. Furthermore, most skin diseases increase in prevalence over a lifetime, resulting in nearly 50% of the Medicare population having at least 1 skin disease and often concurrent skin disease(s). With estimates that by 2030 the $65 years of age US population will grow by 30 million and continue to increase through 2050,11 the burden of skin disease is likely to increase substantially. The pereaffected-person per-year medical cost of treating a diagnosed skin disease showed great variability, ranging from less than $100 (seborrheic dermatitis) to more than $4500 (cutaneous lymphoma), depending on the disease and insurance status. Overall, the aggregate total medical cost of those commercially insured was higher compared with the costs of Medicare and Medicaid populations, although Medicare skin disease patients tended to have higher inpatient and prescription drug costs. These findings also show that dermatologists were seen by 1 in every 3 people diagnosed with skin disease in 2013. In addition, dermatologists provided approximately 50% of surgical care for the treatment of skin disease. These results reinforce the role of these specialists in diagnosing and treating a vast array of skin diseases, many of them of frequent concern to patients, particularly those in the Medicare population.12-14 Among Medicaid patients, there was a smaller percentage of visits to dermatologists compared with patients from the other 2 insurance statuses. This difference may be a reflection of the younger age of Medicaid patients, supported by the finding that the top 10 medications prescribed to this group are mostly for treatment of infections or dermatitis (Fig 7, B). A possible explanation could be that many were probably cared for by pediatricians for some skin diseases and only referred to dermatologists for further evaluation and treatment of lesions or other dermatologic conditions.

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Fig 7. 2013 cost of prescription drugs per insured person. A, The stacked columns (upper panel) represent total cost of skin disease prescription drugs in USD millions segregated by nonspecialty (black) and specialty (gray) drugs for commercial, Medicare, and Medicaid populations. The stacked columns (lower panel) represent the actual cost in USD per person (regardless of having skin disease) by type of prescription drugs (vaccines, specialty and nonspecialty) and by insurance status. The total cost per person by insurer is indicated at the top of each column. B, Relative cost in percentage for the top 10 skin disease drugs (pie charts, red slice) for commercial (top panel), Medicare (middle panel), and Medicaid (lower panel), and a table with the list of skin drugs sorted by descending cost per person. The asterisk indicates a specialty drug.

Within each insured population, the 10 skin diseases with the highest economic burden generally correlated with the most prevalent skin disease categories, but this list also included skin diseases with lower prevalence such as cutaneous

lymphoma, melanoma, and nonmelanoma skin cancer in the commercially insured and Medicaidinsured populations. Collectively, the top 10 most common skin diseases represented [80% of the total medical cost for each insured population.

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Fig 8. Portion of office visits for skin disease delivered by dermatologists. A, The stacked column graphs show the percentage of office visits with a dermatologist (green) compared to other health care providers (gray) for commercial, Medicare, and Medicaid populations. The actual percentages for each category are shown inside the columns. B, The stacked column graphs show the percentage of surgeries performed by a dermatologist (green) compared to other health care providers (gray) for commercial, Medicare, and Medicaid populations. The actual percentages for each category are shown inside the columns. C, These bar graphs represent the top 10 skin disease categories by percentage of office visits to dermatologists in 2013 for commercial (upper panel), Medicare (middle panel) and Medicaid (lower panel). The actual count of office visits performed by all providers for each category is plotted in a logarithmic scale and indicated within each column, while the percentage of these visits to dermatologists is indicated at the top of each column.

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Additionally, the 10 most commonly prescribed drugs that were based on insurance status accounted for 40% of the total health care dollars spent on prescription drugs. These drugs are primarily used to treat psoriasis, acne, and cutaneous infections. Skin disease is a significant and serious health consideration for patients, physicians, and payers. As the US population and health care systems continue to evolve,15 it is critical to develop strategies that ensure effective access to dermatologic treatment in outpatient and inpatient settings across the insurance coverage spectrum, appropriate care coordination and referral to specialists, and resources to support patient self-care when appropriate. The BSD Work Group and the AAD would like to thank the following people: Milliman staff: Tia Goss Sawhney, DrPH; Bruce Pyenson; Helen Blumen, MD; Rong Yi, PhD; Michele Berrios; Alice Cha, MS; and Monica Son. Clinical advisors (alphabetical): AAD members: Tim Berger, MD; Brian Berman, MD, PhD; Michael Bigby, MD; Joi Carter, MD; Brett Coldiron, MD; Terry Cronin, MD; Ralph Daniel, MD; Karen Edison, MD; Ronda Farah, MD; Ron Feldman, MD; Ilona Frieden, MD; Larry Green, MD; John Harris, MD, PhD; Robert Kirsner, MD, PhD; Barbara Mathes, MD; Amy McMichael, MD; Chris Mowad, MD; So Yeon Paek, MD; Jonathan Silverberg, MD; Sabra Sullivan, MD; Michael Tharp, MD; Diane Thiboutot, MD; Hensin Tsao, MD; Vickie Werth, MD; Jashin Wu, MD; and Gil Yosipovitch, MD. Representatives of other organizations: Natasha Atanaskova (National Alopecia Areata Foundation), Clifford Bassett (Asthma and Allergy Foundation of America), Anna Bruckner (Society for Pediatric Dermatology), Adam Friedman, MD (National Eczema Association), Rob Galiano (Wound Healing Society), Sergei Grando, MD (International Pemphigus and Pemphigoid Foundation), Iltefat Hamzavi, MD (Vitiligo Working Group), Sewong Kang, MD (Acne and Rosacea Society), Ellen Kim, MD (US Cutaneous Lymphoma Consortium), Naomi Lawrence, MD (American Society for Dermatologic Surgery and American Society for Dermatologic Surgery), Mark Lebwohl, MD (National Psoriasis Foundation), Edward Maytin (BCC Nevus Syndrome Life Support Network), Amy McMichael, MD (Skin of Color Society), Susan Nedorost, MD (American Contact Dermatitis Society), Tim Straight, MD (Association of Military Dermatologists), and Martin Zaiac, MD (Council for Nail Disorders). AAD staff: Elaine Weiss, Stephanie Peditto, Melanie Tolley Hall, Barbara Greenan, Suzanne Lothary, Leslie

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Stein Lloyd, Cindy Kuhn, Diane Simmons, Krista Kauper, Dan Reyes, Detra Davis, Katie Domanowski, Missy Lundberg, Richard Nelson, Andie Pivarunas, and Jennifer Keating. We also thank any others not listed here who contributed to the development and success of this report. REFERENCES 1. Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134:1527-1534. 2. Obama B. United States health care reform: progress to date and next steps. JAMA. 2016;316:525-532. 3. Arrowsmith J. A decade of change. Nat Rev Drug Discov. 2012; 11:17-18. 4. Tensen E, van der Heijden JP, Jaspers MWM, Witkamp L. Two decades of teledermatology: current status and integration in national healthcare systems. Curr Dermatol Rep. 2016;5:96-104. 5. Bickers DR, Lim HW, Margolis D, et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol. 2006;55:490-500. 6. American Academy of Dermatology/Milliman. Burden of Skin Disease. Avaliable from: URL: www.aad.org/BSD. Accessed August 19, 2016. 7. Lim HW, Collins SAB, Resneck JS, et al. The burden of skin disease in the United States. J Am Acad Dermatol. 2017. In press. 8. Young K, Rudowitz R, Rouhani S, Garfield R. Medicaid per enrollee spending: variation across states. Kaiser Family Foundation; 2015. Available from: URL: http://kff.org/reportsection/medicaid-per-enrollee-spending-appendices/. Accessed March 29, 2016. 9. Couglin TA, Holahan J, Caswell K, McGrath M. Uncompensated care for the uninsured in 2013: a detailed examination. Kaiser Fam Found; 2014. Available from: URL: http://kff.org/report-section/ uncompensated-care-for-the-uninsured-in-2013-a-detailedexamination-the-cost-of-uncompensated-care/. Accessed March 29, 2016. 10. Milliman. Health Cost Guidelines. Grouper; Available from: URL: http://usmillimancom/Solutions/Products/Resources/ Health-Cost-Guidelines/Health-Cost-Guidelines--Grouper/. Accessed April 23, 2016. 11. Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in the United States. From the US Census Bureau; 2014. Available from: URL: http://wwwcensusgov/library/ publications/2014/demo/p25-1140html. Accessed October 6, 2016. 12. Landis ET, Davis SA, Taheri A, Feldman SR. Top dermatologic diagnoses by age. Dermatol Online J. 2014;20:22368. 13. Tellechea O, Cardoso JC, Reis JP, et al. Benign follicular tumors. Anais brasileiros de dermatologia. 2015;90:780-796. 14. Adamson AS, Dusetzina SB. Characteristics of Medicare payments to dermatologists in 2013. JAMA Dermatol. 2017;153:95-97. 15. Kirby JS, BA, Rosamilia L, Miller JJ. Improving Dermatological Care in Primary Care: Consideration of the Collaborative Care Model. Austin J Dermatol. 2016;3:1050.

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

to to to to to to to to

Other Other Other Other Surg Surg Surg Surg

0015F 01951 01952 01953 10040 10060 10061 10080

Refer Refer Refer Refer Refer Refer Refer Refer

x

Surg

10081

Refer to an AMA-licensed code list

x x x x x x x x x x x x x x x

Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg

10120 10121 10160 11000 11001 11042 11045 11055 11056 11057 11100 11101 11200 11201 11300

Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer

x

Surg

11301

Refer to an AMA-licensed code list

x

Surg

11302

Refer to an AMA-licensed code list

x

Surg

11303

Refer to an AMA-licensed code list

x

Surg

11305

Refer to an AMA-licensed code list

x

Surg

11306

Refer to an AMA-licensed code list

an an an an an an an an an an an an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code code code code code

code code code code code code code code code code code code code code code

list list list list list list list list

list list list list list list list list list list list list list list list

Nonstandard benefit - temporary codes Anesthesia - burn excisions or debridement Anesthesia - burn excisions or debridement Anesthesia - burn excisions or debridement Surgery - integumentary system - acne - skin Surgery - integumentary system - incision and drainage - skin Surgery - integumentary system - incision and drainage - skin Surgery - integumentary system - incision and drainage pilonidal cyst Surgery - integumentary system - incision and drainage pilonidal cyst Surgery - integumentary system - incision and drainage - skin Surgery - integumentary system - incision and drainage - skin Surgery - integumentary system - incision and drainage - skin Surgery - integumentary system - debridement - skin Surgery - integumentary system - debridement - skin Surgery - integumentary system - debridement - skin Surgery - integumentary system - debridement - skin Surgery - integumentary system - paring or curettement - skin Surgery - integumentary system - paring or curettement - skin Surgery - integumentary system - paring or curettement - skin Surgery - integumentary system - biopsy - skin Surgery - integumentary system - biopsy - skin Surgery - integumentary system - removal of skin tags - skin Surgery - integumentary system - removal of skin tags - skin Surgery - integumentary system - shaving of lesions - skin of trunk, arms, legs Surgery - integumentary system - shaving of lesions - skin of trunk, arms, legs Surgery - integumentary system - shaving of lesions - skin of trunk, arms, legs Surgery - integumentary system - shaving of lesions - skin of trunk, arms, legs Surgery - integumentary system - shaving of lesions - skin of scalp, neck, hands, feet Surgery - integumentary system - shaving of lesions - skin of scalp, neck, hands, feet Continued

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x x x x x x x x

to to to to to to to to to to to to to to to

an an an an an an an an

Family description

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Supplemental Table I. HCPCS code lists: evaluation and management visits, skin procedures, and skin vaccines

E and M visit

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Surg

11307

Refer to an AMA-licensed code list

x

Surg

11308

Refer to an AMA-licensed code list

x

Surg

11310

Refer to an AMA-licensed code list

x

Surg

11311

Refer to an AMA-licensed code list

x

Surg

11312

Refer to an AMA-licensed code list

x

Surg

11313

Refer to an AMA-licensed code list

x

Surg

11400

Refer to an AMA-licensed code list

x

Surg

11401

Refer to an AMA-licensed code list

x

Surg

11402

Refer to an AMA-licensed code list

x

Surg

11403

Refer to an AMA-licensed code list

x

Surg

11404

Refer to an AMA-licensed code list

x

Surg

11406

Refer to an AMA-licensed code list

x

Surg

11420

Refer to an AMA-licensed code list

x

Surg

11421

Refer to an AMA-licensed code list

x

Surg

11422

Refer to an AMA-licensed code list

x

Surg

11423

Refer to an AMA-licensed code list

x

Surg

11424

Refer to an AMA-licensed code list

x

Surg

11426

Refer to an AMA-licensed code list

x

Surg

11440

Refer to an AMA-licensed code list

shaving of lesions - skin of shaving of lesions - skin of shaving of lesions - skin of shaving of lesions - skin of shaving of lesions - skin of shaving of lesions - skin of excision of benign lesions excision of benign lesions excision of benign lesions excision of benign lesions excision of benign lesions excision of benign lesions excision of benign lesions excision of benign lesions excision of benign lesions excision of benign lesions excision of benign lesions excision of benign lesions excision of benign lesions Continued

n 2017

Surgery - integumentary system scalp, neck, hands, feet Surgery - integumentary system scalp, neck, hands, feet Surgery - integumentary system face etc Surgery - integumentary system face etc Surgery - integumentary system face etc Surgery - integumentary system face etc Surgery - integumentary system skin of trunk, arms, legs Surgery - integumentary system skin of trunk, arms, legs Surgery - integumentary system skin of trunk, arms, legs Surgery - integumentary system skin of trunk, arms, legs Surgery - integumentary system skin of trunk, arms, legs Surgery - integumentary system skin of trunk, arms, legs Surgery - integumentary system skin of scalp, neck, hands, feet Surgery - integumentary system skin of scalp, neck, hands, feet Surgery - integumentary system skin of scalp, neck, hands, feet Surgery - integumentary system skin of scalp, neck, hands, feet Surgery - integumentary system skin of scalp, neck, hands, feet Surgery - integumentary system skin of scalp, neck, hands, feet Surgery - integumentary system skin of face, etc

J AM ACAD DERMATOL

x

Family description

10.e2 Lim et al

Supplemental Table I. Cont’d

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Surg

11441

Refer to an AMA-licensed code list

x

Surg

11442

Refer to an AMA-licensed code list

x

Surg

11443

Refer to an AMA-licensed code list

x

Surg

11444

Refer to an AMA-licensed code list

x

Surg

11446

Refer to an AMA-licensed code list

x

Surg

11450

Refer to an AMA-licensed code list

x

Surg

11451

Refer to an AMA-licensed code list

x

Surg

11462

Refer to an AMA-licensed code list

x

Surg

11463

Refer to an AMA-licensed code list

x

Surg

11470

Refer to an AMA-licensed code list

x

Surg

11471

Refer to an AMA-licensed code list

x

Surg

11600

Refer to an AMA-licensed code list

x

Surg

11601

Refer to an AMA-licensed code list

x

Surg

11602

Refer to an AMA-licensed code list

x

Surg

11603

Refer to an AMA-licensed code list

x

Surg

11604

Refer to an AMA-licensed code list

x

Surg

11606

Refer to an AMA-licensed code list

x

Surg

11620

Refer to an AMA-licensed code list

x

Surg

11621

Refer to an AMA-licensed code list

Surgery - integumentary system - excision of benign lesions skin of face, etc Surgery - integumentary system - excision of benign lesions skin of face, etc Surgery - integumentary system - excision of benign lesions skin of face, etc Surgery - integumentary system - excision of benign lesions skin of face, etc Surgery - integumentary system - excision of benign lesions skin of face, etc Surgery - integumentary system - excision of benign lesions skin of sweat glands Surgery - integumentary system - excision of benign lesions skin of sweat glands Surgery - integumentary system - excision of benign lesions skin of sweat glands Surgery - integumentary system - excision of benign lesions skin of sweat glands Surgery - integumentary system - excision of benign lesions skin of sweat glands Surgery - integumentary system - excision of benign lesions skin of sweat glands Surgery - integumentary system - excision of malignant lesions - skin of trunk, arms, legs Surgery - integumentary system - excision of malignant lesions - skin of trunk, arms, legs Surgery - integumentary system - excision of malignant lesions - skin of trunk, arms, legs Surgery - integumentary system - excision of malignant lesions - skin of trunk, arms, legs Surgery - integumentary system - excision of malignant lesions - skin of trunk, arms, legs Surgery - integumentary system - excision of malignant lesions - skin of trunk, arms, legs Surgery - integumentary system - excision of malignant lesions - skin of scalp, neck, hands, feet Surgery - integumentary system - excision of malignant lesions - skin of scalp, neck, hands, feet Continued

Lim et al 10.e3

x

Family description

J AM ACAD DERMATOL

E and M visit

VOLUME jj, NUMBER j

Supplemental Table I. Cont’d

E and M visit

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Family description

11622

Refer to an AMA-licensed code list

x

Surg

11623

Refer to an AMA-licensed code list

x

Surg

11624

Refer to an AMA-licensed code list

x

Surg

11626

Refer to an AMA-licensed code list

x

Surg

11640

Refer to an AMA-licensed code list

x

Surg

11641

Refer to an AMA-licensed code list

x

Surg

11642

Refer to an AMA-licensed code list

x

Surg

11643

Refer to an AMA-licensed code list

x

Surg

11644

Refer to an AMA-licensed code list

x

Surg

11646

Refer to an AMA-licensed code list

x x x x x x x x x x

Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg

11719 11720 11721 11730 11732 11740 11750 11752 11755 11760

Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer

x

Surg

11762

Refer to an AMA-licensed code list

x x x x x

Surg Surg Surg Surg Surg

11765 11770 11771 11772 11900

Refer Refer Refer Refer Refer

to to to to to to to to to to

to to to to to

an an an an an an an an an an

an an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code code code code code code code

code code code code code

list list list list list list list list list list

list list list list list

Surgery - integumentary system - excision of malignant lesions - skin of scalp, neck, hands, feet Surgery - integumentary system - excision of malignant lesions - skin of scalp, neck, hands, feet Surgery - integumentary system - excision of malignant lesions - skin of scalp, neck, hands, feet Surgery - integumentary system - excision of malignant lesions - skin of scalp, neck, hands, feet Surgery - integumentary system - excision of malignant lesions - skin of face, etc Surgery - integumentary system - excision of malignant lesions - skin of face, etc Surgery - integumentary system - excision of malignant lesions - skin of face, etc Surgery - integumentary system - excision of malignant lesions - skin of face, etc Surgery - integumentary system - excision of malignant lesions - skin of face, etc Surgery - integumentary system - excision of malignant lesions - skin of face, etc Surgery - integumentary system - paring or curettement - nails Surgery - integumentary system - debridement - nails Surgery - integumentary system - debridement - nails Surgery - integumentary system - excision - nails Surgery - integumentary system - excision - nails Surgery - integumentary system - incision and drainage - nails Surgery - integumentary system - excision - nails Surgery - integumentary system - excision - nails surgery - integumentary system - biopsy - nails surgery - integumentary system - repair and/or reconstruction nails Surgery - integumentary system - repair and/or reconstruction nails Surgery - integumentary system - excision - nails Surgery - integumentary system - excision - pilonidal cyst Surgery - integumentary system - excision - pilonidal cyst Surgery - integumentary system - excision - pilonidal cyst Surgery - integumentary system - epidermal introduction - skin Continued

n 2017

Surg

J AM ACAD DERMATOL

x

10.e4 Lim et al

Supplemental Table I. Cont’d

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

to to to to to to to to to

an an an an an an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code code code code code code

Family description

Surg Surg Surg Surg Surg Surg Surg Surg Surg

11901 11920 11921 11922 11950 11951 11952 11954 12001

Refer Refer Refer Refer Refer Refer Refer Refer Refer

list list list list list list list list list

x

Surg

12002

Refer to an AMA-licensed code list

x

Surg

12004

Refer to an AMA-licensed code list

x

Surg

12005

Refer to an AMA-licensed code list

x

Surg

12006

Refer to an AMA-licensed code list

x

Surg

12007

Refer to an AMA-licensed code list

x

Surg

12011

Refer to an AMA-licensed code list

x

Surg

12013

Refer to an AMA-licensed code list

x

Surg

12014

Refer to an AMA-licensed code list

x

Surg

12015

Refer to an AMA-licensed code list

x

Surg

12016

Refer to an AMA-licensed code list

x

Surg

12017

Refer to an AMA-licensed code list

x

Surg

12018

Refer to an AMA-licensed code list

x

Surg

12020

Refer to an AMA-licensed code list

x

Surg

12021

Refer to an AMA-licensed code list

Surgery - integumentary system - epidermal introduction - skin Surgery - integumentary system - epidermal introduction - skin Surgery - integumentary system - epidermal introduction - skin Surgery - integumentary system - epidermal introduction - skin Surgery - integumentary system - epidermal introduction - skin Surgery - integumentary system - epidermal introduction - skin Surgery - integumentary system - epidermal introduction - skin Surgery - integumentary system - epidermal introduction - skin Surgery - integumentary system - repair/closure of wounds simple - skin of scalp, neck, hands, feet Surgery - integumentary system - repair/closure of wounds simple - skin of scalp, neck, hands, feet Surgery - integumentary system - repair/closure of wounds simple - skin of scalp, neck, hands, feet Surgery - integumentary system - repair/closure of wounds simple - skin of scalp, neck, hands, feet Surgery - integumentary system - repair/closure of wounds simple - skin of scalp, neck, hands, feet Surgery - integumentary system - repair/closure of wounds simple - skin of scalp, neck, hands, feet Surgery - integumentary system - repair/closure of wounds simple - skin of face, etc Surgery - integumentary system - repair/closure of wounds simple - skin of face, etc Surgery - integumentary system - repair/closure of wounds simple - skin of face, etc Surgery - integumentary system - repair/closure of wounds simple - skin of face, etc Surgery - integumentary system - repair/closure of wounds simple - skin of face, etc Surgery - integumentary system - repair/closure of wounds simple - skin of face, etc Surgery - integumentary system - repair/closure of wounds simple e skin Surgery - integumentary system - repair/closure of wounds simple e skin Surgery - integumentary system - repair/closure of wounds simple e skin Continued

Lim et al 10.e5

x x x x x x x x x

J AM ACAD DERMATOL

E and M visit

VOLUME jj, NUMBER j

Supplemental Table I. Cont’d

E and M visit

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Surg

12031

Refer to an AMA-licensed code list

x

Surg

12032

Refer to an AMA-licensed code list

x

Surg

12034

Refer to an AMA-licensed code list

x

Surg

12035

Refer to an AMA-licensed code list

x

Surg

12036

Refer to an AMA-licensed code list

x

Surg

12037

Refer to an AMA-licensed code list

x

Surg

12041

Refer to an AMA-licensed code list

x

Surg

12042

Refer to an AMA-licensed code list

x

Surg

12044

Refer to an AMA-licensed code list

x

Surg

12045

Refer to an AMA-licensed code list

x

Surg

12046

Refer to an AMA-licensed code list

x

Surg

12047

Refer to an AMA-licensed code list

x

Surg

12051

Refer to an AMA-licensed code list

x

Surg

12052

Refer to an AMA-licensed code list

x

Surg

12053

Refer to an AMA-licensed code list

x

Surg

12054

Refer to an AMA-licensed code list

x

Surg

12055

Refer to an AMA-licensed code list

x

Surg

12056

Refer to an AMA-licensed code list

x

Surg

12057

Refer to an AMA-licensed code list

of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds of wounds Continued

n 2017

Surgery - integumentary system - repair/closure intermediate - skin of scalp, axillae, trunk Surgery - integumentary system - repair/closure intermediate - skin of scalp, axillae, trunk Surgery - integumentary system - repair/closure intermediate - skin of scalp, axillae, trunk Surgery - integumentary system - repair/closure intermediate - skin of scalp, axillae, trunk Surgery - integumentary system - repair/closure intermediate - skin of scalp, axillae, trunk Surgery - integumentary system - repair/closure intermediate - skin of scalp, axillae, trunk Surgery - integumentary system - repair/closure intermediate - skin of neck, hands, feet Surgery - integumentary system - repair/closure intermediate - skin of neck, hands, feet Surgery - integumentary system - repair/closure intermediate - skin of neck, hands, feet Surgery - integumentary system - repair/closure intermediate - skin of neck, hands, feet Surgery - integumentary system - repair/closure intermediate - skin of neck, hands, feet Surgery - integumentary system - repair/closure intermediate - skin of neck, hands, feet Surgery - integumentary system - repair/closure intermediate - skin of neck, hands, feet Surgery - integumentary system - repair/closure intermediate - skin of face, etc Surgery - integumentary system - repair/closure intermediate - skin of face, etc Surgery - integumentary system - repair/closure intermediate - skin of face, etc Surgery - integumentary system - repair/closure intermediate - skin of face, etc Surgery - integumentary system - repair/closure intermediate - skin of face, etc Surgery - integumentary system - repair/closure intermediate - skin of face, etc

J AM ACAD DERMATOL

x

Family description

10.e6 Lim et al

Supplemental Table I. Cont’d

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Surg

13100

Refer to an AMA-licensed code list

x

Surg

13101

Refer to an AMA-licensed code list

x

Surg

13102

Refer to an AMA-licensed code list

x

Surg

13120

Refer to an AMA-licensed code list

x

Surg

13121

Refer to an AMA-licensed code list

x

Surg

13122

Refer to an AMA-licensed code list

x

Surg

13131

Refer to an AMA-licensed code list

x

Surg

13132

Refer to an AMA-licensed code list

x

Surg

13133

Refer to an AMA-licensed code list

x

Surg

13150

Refer to an AMA-licensed code list

x

Surg

13151

Refer to an AMA-licensed code list

x

Surg

13152

Refer to an AMA-licensed code list

x

Surg

13153

Refer to an AMA-licensed code list

x

Surg

13160

Refer to an AMA-licensed code list

x

Surg

14000

Refer to an AMA-licensed code list

x

Surg

14001

Refer to an AMA-licensed code list

x

Surg

14020

Refer to an AMA-licensed code list

x

Surg

14021

Refer to an AMA-licensed code list

x

Surg

14040

Refer to an AMA-licensed code list

Surgery - integumentary system - repair/closure of wounds complex - skin of trunk/arms/legs Surgery - integumentary system - repair/closure of wounds complex - skin of trunk/arms/legs Surgery - integumentary system - repair/closure of wounds complex - skin of trunk/arms/legs Surgery - integumentary system - repair/closure of wounds complex - skin of scalp, arms, legs Surgery - integumentary system - repair/closure of wounds complex - skin of scalp, arms, legs Surgery - integumentary system - repair/closure of wounds complex - skin of scalp, arms, legs Surgery - integumentary system - repair/closure of wounds complex - skin of forehead, cheeks Surgery - integumentary system - repair/closure of wounds complex - skin of forehead, cheeks Surgery - integumentary system - repair/closure of wounds complex - skin of forehead, cheeks Surgery - integumentary system - repair/closure of wounds complex - skin of eyelids, nose Surgery - integumentary system - repair/closure of wounds complex - skin of eyelids, nose Surgery - integumentary system - repair/closure of wounds complex - skin of eyelids, nose Surgery - integumentary system - repair/closure of wounds complex - skin of eyelids, nose Surgery - integumentary system - repair/closure of wounds complex - skin Surgery - integumentary system - tissue rearrangement - skin of trunk/arms/legs Surgery - integumentary system - tissue rearrangement - skin of trunk/arms/legs Surgery - integumentary system - tissue rearrangement - skin of scalp, arms, legs Surgery - integumentary system - tissue rearrangement - skin of scalp, arms, legs Surgery - integumentary system - tissue rearrangement - skin of forehead, cheeks Continued

Lim et al 10.e7

x

Family description

J AM ACAD DERMATOL

E and M visit

VOLUME jj, NUMBER j

Supplemental Table I. Cont’d

E and M visit

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Surg

14041

Refer to an AMA-licensed code list

x

Surg

14060

Refer to an AMA-licensed code list

x

Surg

14061

Refer to an AMA-licensed code list

x

Surg

14301

Refer to an AMA-licensed code list

x

Surg

14302

Refer to an AMA-licensed code list

x x

Surg Surg

14350 15002

Refer to an AMA-licensed code list Refer to an AMA-licensed code list

x

Surg

15003

Refer to an AMA-licensed code list

x

Surg

15004

Refer to an AMA-licensed code list

x

Surg

15005

Refer to an AMA-licensed code list

x

Surg

15040

Refer to an AMA-licensed code list

x

Surg

15050

Refer to an AMA-licensed code list

x

Surg

15100

Refer to an AMA-licensed code list

x

Surg

15101

Refer to an AMA-licensed code list

x

Surg

15110

Refer to an AMA-licensed code list

x

Surg

15111

Refer to an AMA-licensed code list

x

Surg

15115

Refer to an AMA-licensed code list

x

Surg

15116

Refer to an AMA-licensed code list

x

Surg

15120

Refer to an AMA-licensed code list

Surgery - integumentary system - tissue rearrangement - skin of forehead, cheeks Surgery - integumentary system - tissue rearrangement - skin of eyelids, nose Surgery - integumentary system - tissue rearrangement - skin of eyelids, nose Surgery - integumentary system - tissue rearrangement - skin of forehead, cheeks Surgery - integumentary system - tissue rearrangement - skin of forehead, cheeks Surgery - integumentary system - tissue rearrangement - skin Surgery - integumentary system - surgical preparation - skin of trunk/arms/legs Surgery - integumentary system - surgical preparation - skin of face, etc Surgery - integumentary system - surgical preparation - skin of face, etc Surgery - integumentary system - surgical preparation - skin of face, etc Surgery - integumentary system - grafts - autograft/tissue cultured autograft e skin Surgery - integumentary system - grafts - autograft/tissue cultured autograft e skin Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of trunk/arms/legs Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of trunk/arms/legs Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of trunk/arms/legs Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of trunk/arms/legs Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of face, etc Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of face, etc Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of face, etc

n 2017

Continued

J AM ACAD DERMATOL

x

Family description

10.e8 Lim et al

Supplemental Table I. Cont’d

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Surg

15121

Refer to an AMA-licensed code list

x

Surg

15130

Refer to an AMA-licensed code list

x

Surg

15131

Refer to an AMA-licensed code list

x

Surg

15135

Refer to an AMA-licensed code list

x

Surg

15136

Refer to an AMA-licensed code list

x

Surg

15150

Refer to an AMA-licensed code list

x

Surg

15151

Refer to an AMA-licensed code list

x

Surg

15152

Refer to an AMA-licensed code list

x

Surg

15155

Refer to an AMA-licensed code list

x

Surg

15156

Refer to an AMA-licensed code list

x

Surg

15157

Refer to an AMA-licensed code list

x

Surg

15200

Refer to an AMA-licensed code list

x

Surg

15201

Refer to an AMA-licensed code list

x

Surg

15220

Refer to an AMA-licensed code list

x

Surg

15221

Refer to an AMA-licensed code list

x

Surg

15240

Refer to an AMA-licensed code list

x

Surg

15241

Refer to an AMA-licensed code list

x

Surg

15260

Refer to an AMA-licensed code list

x

Surg

15261

Refer to an AMA-licensed code list

Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of face, etc Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of trunk/arms/legs Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of trunk/arms/legs Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of face, etc Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of face, etc Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of trunk/arms/legs Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of trunk/arms/legs Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of trunk/arms/legs Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of face, etc Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of face, etc Surgery - integumentary system - grafts - autograft/tissue cultured autograft - skin of face, etc Surgery - integumentary system - grafts - acellular dermal replacement - skin of trunk Surgery - integumentary system - grafts - acellular dermal replacement - skin of trunk Surgery - integumentary system - grafts - acellular dermal replacement - skin of scalp, arms, legs Surgery - integumentary system - grafts - acellular dermal replacement - skin of scalp, arms, legs Surgery - integumentary system - grafts - acellular dermal replacement - skin of face, etc Surgery - integumentary system - grafts - acellular dermal replacement - skin of face, etc Surgery - integumentary system - grafts - acellular dermal replacement - skin of eyelids, nose Surgery - integumentary system - grafts - acellular dermal replacement - skin of eyelids, nose Continued

Lim et al 10.e9

x

Family description

J AM ACAD DERMATOL

E and M visit

VOLUME jj, NUMBER j

Supplemental Table I. Cont’d

E and M visit

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Family description

15271

Refer to an AMA-licensed code list

x

Surg

15272

Refer to an AMA-licensed code list

x

Surg

15273

Refer to an AMA-licensed code list

x

Surg

15274

Refer to an AMA-licensed code list

x

Surg

15275

Refer to an AMA-licensed code list

x

Surg

15276

Refer to an AMA-licensed code list

x

Surg

15277

Refer to an AMA-licensed code list

x

Surg

15278

Refer to an AMA-licensed code list

x x x

Surg Surg Surg

15570 15572 15574

Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list

x x x x

Surg Surg Surg Surg

15576 15600 15610 15620

Refer Refer Refer Refer

to to to to

an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code

list list list list

x x x x x x x x x x x x x

Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg

15630 15650 15731 15760 15775 15776 15777 15780 15781 15782 15783 15786 15787

Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer

to to to to to to to to to to to to to

an an an an an an an an an an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code code code code code code code code code code

list list list list list list list list list list list list list

Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of trunk/arms/legs Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of trunk/arms/legs Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of trunk/arms/legs Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of trunk/arms/legs Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of face, etc Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of face, etc Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of face, etc Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of face, etc Surgery - integumentary system - flaps - skin of trunk Surgery - integumentary system - flaps - skin of scalp, arms, legs Surgery - integumentary system - flaps - skin of forehead, cheeks Surgery - integumentary system - flaps - skin of eyelids, nose Surgery - integumentary system - flaps - skin of trunk Surgery - integumentary system - flaps - skin of scalp, arms, legs Surgery - integumentary system - flaps - skin of forehead, cheeks Surgery - integumentary system - flaps - skin of eyelids, nose Surgery - integumentary system - flaps - skin Surgery - integumentary system - flaps - skin Surgery - integumentary system - other flaps and grafts - skin Surgery - integumentary system - other flaps and grafts - skin Surgery - integumentary system - other flaps and grafts - skin Surgery - integumentary system - other flaps and grafts - skin Surgery - integumentary system - abrasions - skin Surgery - integumentary system - abrasions - skin Surgery - integumentary system - abrasions - skin Surgery - integumentary system - abrasions - skin Surgery - integumentary system - abrasions - skin Surgery - integumentary system - abrasions - skin Continued

n 2017

Surg

J AM ACAD DERMATOL

x

10.e10 Lim et al

Supplemental Table I. Cont’d

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to

an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code

Family description

Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg Surg

15788 15789 15792 15793 15819 15824 15825 15826 15828 15829 15830 15832 15833 15834 15835 15836 15837 15838 15839 15840 15841 15842 15845 15847 15850 15851 15852 15876 15877 15878 15879 15920

Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer

list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list

x

Surg

15931

Refer to an AMA-licensed code list

x

Surg

15934

Refer to an AMA-licensed code list

Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery skin Surgery skin Surgery skin

-

integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary integumentary

system system system system system system system system system system system system system system system system system system system system system system system system system system system system system system system system

-

peels - skin peels - skin peels - skin peels - skin other procedures - skin rhytidectomy - skin rhytidectomy - skin rhytidectomy - skin rhytidectomy - skin rhytidectomy - skin lipectomy - skin lipectomy - skin lipectomy - skin lipectomy - skin lipectomy - skin lipectomy - skin lipectomy - skin lipectomy - skin lipectomy - skin facial muscle - skin facial muscle - skin facial muscle - skin facial muscle - skin lipectomy - skin other procedures - skin other procedures - skin other procedures - skin lipectomy - skin lipectomy - skin lipectomy - skin lipectomy - skin ulcers and pressure sores -

- integumentary system - ulcers and pressure sores - integumentary system - ulcers and pressure sores Continued

Lim et al 10.e11

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

J AM ACAD DERMATOL

E and M visit

VOLUME jj, NUMBER j

Supplemental Table I. Cont’d

E and M visit

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Family description

Surg

15936

Refer to an AMA-licensed code list

x

Surg

15940

Refer to an AMA-licensed code list

x

Surg

15944

Refer to an AMA-licensed code list

x

Surg

15946

Refer to an AMA-licensed code list

x

Surg

15950

Refer to an AMA-licensed code list

x

Surg

15952

Refer to an AMA-licensed code list

x

Surg

15956

Refer to an AMA-licensed code list

x

Surg

15999

Refer to an AMA-licensed code list

x x x x x x x

Surg Surg Surg Surg Surg Surg Surg

16000 16020 16025 16030 16035 16036 17000

Refer Refer Refer Refer Refer Refer Refer

x

Surg

17003

Refer to an AMA-licensed code list

x

Surg

17004

Refer to an AMA-licensed code list

x

Surg

17106

Refer to an AMA-licensed code list

x

Surg

17107

Refer to an AMA-licensed code list

x

Surg

17108

Refer to an AMA-licensed code list

x

Surg

17110

Refer to an AMA-licensed code list

x

Surg

17111

Refer to an AMA-licensed code list

to to to to to to to

an an an an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code code code code

list list list list list list list

- ulcers and pressure sores - ulcers and pressure sores - ulcers and pressure sores - ulcers and pressure sores - ulcers and pressure sores - ulcers and pressure sores - ulcers and pressure sores - ulcers and pressure sores -

burns - skin burns - skin burns - skin burns - skin burns - skin burns - skin destruction, benign or

- destruction, benign or - destruction, benign or - destruction, benign or - destruction, benign or - destruction, benign or - destruction, benign or - destruction, benign or Continued

n 2017

Surgery - integumentary system skin Surgery - integumentary system skin Surgery - integumentary system skin Surgery - integumentary system skin Surgery - integumentary system skin Surgery - integumentary system skin Surgery - integumentary system skin Surgery - integumentary system skin Surgery - integumentary system Surgery - integumentary system Surgery - integumentary system Surgery - integumentary system Surgery - integumentary system Surgery - integumentary system Surgery - integumentary system premalignant lesions - skin Surgery - integumentary system premalignant lesions - skin Surgery - integumentary system premalignant lesions - skin Surgery - integumentary system premalignant lesions - skin Surgery - integumentary system premalignant lesions - skin Surgery - integumentary system premalignant lesions - skin Surgery - integumentary system premalignant lesions - skin Surgery - integumentary system premalignant lesions - skin

J AM ACAD DERMATOL

x

10.e12 Lim et al

Supplemental Table I. Cont’d

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Surg

17250

Refer to an AMA-licensed code list

x

Surg

17260

Refer to an AMA-licensed code list

x

Surg

17261

Refer to an AMA-licensed code list

x

Surg

17262

Refer to an AMA-licensed code list

x

Surg

17263

Refer to an AMA-licensed code list

x

Surg

17264

Refer to an AMA-licensed code list

x

Surg

17266

Refer to an AMA-licensed code list

x

Surg

17270

Refer to an AMA-licensed code list

x

Surg

17271

Refer to an AMA-licensed code list

x

Surg

17272

Refer to an AMA-licensed code list

x

Surg

17273

Refer to an AMA-licensed code list

x

Surg

17274

Refer to an AMA-licensed code list

x

Surg

17276

Refer to an AMA-licensed code list

x

Surg

17280

Refer to an AMA-licensed code list

x

Surg

17281

Refer to an AMA-licensed code list

x

Surg

17282

Refer to an AMA-licensed code list

x

Surg

17283

Refer to an AMA-licensed code list

x

Surg

17284

Refer to an AMA-licensed code list

x

Surg

17286

Refer to an AMA-licensed code list

Surgery - integumentary system premalignant lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin Surgery - integumentary system lesions - skin

- destruction, benign or - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant - destruction, malignant Continued

Lim et al 10.e13

x

Family description

J AM ACAD DERMATOL

E and M visit

VOLUME jj, NUMBER j

Supplemental Table I. Cont’d

E and M visit

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Family description

17311

Refer to an AMA-licensed code list

x

Surg

17312

Refer to an AMA-licensed code list

x

Surg

17313

Refer to an AMA-licensed code list

x

Surg

17314

Refer to an AMA-licensed code list

x

Surg

17315

Refer to an AMA-licensed code list

x

Surg

17340

Refer to an AMA-licensed code list

x

Surg

17360

Refer to an AMA-licensed code list

x

Surg

17380

Refer to an AMA-licensed code list

x

Surg

17999

Refer to an AMA-licensed code list

x x x x x x

Other Surg Surg Surg Other Other

x x x x x

o o o o o

2029F 30120 30124 30125 87101 88233 90649 90650 90705 90706 90707 90708 90710 90716 90736 96567 96570 96571 96900 96902

Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer

x x x x x x x x x

to to to to to to to to to to to to to to to to to to to to

an an an an an an an an an an an an an an an an an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code code code code code code code code code code code code code code code code code

list list list list list list list list list list list list list list list list list list list list

Surgery - integumentary system - Mohs micrographic surgery skin Surgery - integumentary system - Mohs micrographic surgery skin Surgery - integumentary system - Mohs micrographic surgery skin Surgery - integumentary system - Mohs micrographic surgery skin Surgery - integumentary system - Mohs micrographic surgery skin Surgery - integumentary system - destruction, other procedures - skin Surgery - integumentary system - destruction, other procedures - skin Surgery - integumentary system - destruction, other procedures - skin Surgery - integumentary system - destruction, other procedures - skin Nonstandard benefit - temporary codes Surgery - respiratory system - excision - nose Surgery - respiratory system - excision - nose Surgery - respiratory system - excision - nose Pathology and laboratory - microbiology Pathology and laboratory - cytogenetic studies Immunizations - materials Immunizations - materials Immunizations - materials Immunizations - materials Immunizations - materials Immunizations - materials Immunizations - materials Immunizations - materials Immunizations - materials Miscellaneous medical - dermatology - photodynamic therapy Miscellaneous medical - dermatology - photodynamic therapy Miscellaneous medical - dermatology - photodynamic therapy Miscellaneous medical - dermatology - special procedures Miscellaneous medical - dermatology - special procedures Continued

n 2017

Surg

J AM ACAD DERMATOL

x

10.e14 Lim et al

Supplemental Table I. Cont’d

Skin vacc

Skin proc

x x x x x x x x

o o o o o o o o

HCPCS sode

96904 96910 96912 96913 96920 96921 96922 96999 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99217 99218 99219 99220 99221 99222 99223 99224 99225 99226 99231 99232 99233 99234 99235 99236 99238 99239 99241 99242

Code description

Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer

to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to

an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code

Family description

list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list

Miscellaneous medical - dermatology Miscellaneous medical - dermatology Miscellaneous medical - dermatology Miscellaneous medical - dermatology Miscellaneous medical - dermatology Miscellaneous medical - dermatology Miscellaneous medical - dermatology Miscellaneous medical - dermatology Office/home visits - office visits Office/home visits - office visits Office/home visits - office visits Office/home visits - office visits Office/home visits - office visits Office/home visits - office visits Office/home visits - office visits Office/home visits - office visits Office/home visits - office visits Office/home visits - office visits ER visits and observation care ER visits and observation care ER visits and observation care ER visits and observation care IP visits - hospital visits IP visits - hospital visits IP visits - hospital visits ER visits and observation care ER visits and observation care ER visits and observation care IP visits - hospital visits IP visits - hospital visits IP visits - hospital visits ER visits and observation care ER visits and observation care ER visits and observation care IP visits - hospital visits IP visits - hospital visits Consults Consults

-

special special special special special special special special

procedures procedures procedures procedures procedures procedures procedures procedures

Continued

Lim et al 10.e15

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

Proc type

J AM ACAD DERMATOL

E and M visit

VOLUME jj, NUMBER j

Supplemental Table I. Cont’d

E and M visit

Skin proc

Proc type

HCPCS sode

Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer

to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to

an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code

Family description

list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list

Consults Consults Consults Consults Consults Consults Consults Consults ER visits and observation care ER visits and observation care ER visits and observation care ER visits and observation care ER visits and observation care ER visits and observation care IP visits - critical care services IP visits - critical care services IP visits - nursing facility services IP visits - nursing facility services IP visits - nursing facility services IP visits - nursing facility services IP visits - nursing facility services IP visits - nursing facility services IP visits - nursing facility services IP visits - nursing facility services IP visits - nursing facility services IP visits - nursing facility services Office/home visits - rest home Office/home visits - rest home Office/home visits - rest home Office/home visits - rest home Office/home visits - rest home Office/home visits - rest home Office/home visits - rest home Office/home visits - rest home Office/home visits - rest home Office/home visits - care plan oversight services Office/home visits - care plan oversight services Office/home visits - home visits Continued

n 2017

99243 99244 99245 99251 99252 99253 99254 99255 99281 99282 99283 99284 99285 99288 99291 99292 99304 99305 99306 99307 99308 99309 99310 99315 99316 99318 99324 99325 99326 99327 99328 99334 99335 99336 99337 99339 99340 99341

Code description

J AM ACAD DERMATOL

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

Skin vacc

10.e16 Lim et al

Supplemental Table I. Cont’d

Skin proc

Proc type

HCPCS sode

99342 99343 99344 99345 99347 99348 99349 99350 99354 99355 99356 99357 99358 99359 99360 99363 99364 99366 99367 99368 99374 99375 99377 99378 99379 99380 99381 99382 99383 99384 99385 99386 99387 99391 99392 99393 99394 99395

Code description

Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer

to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to

an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code code

Family description

list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list list

Office/home visits - home visits Office/home visits - home visits Office/home visits - home visits Office/home visits - home visits Office/home visits - home visits Office/home visits - home visits Office/home visits - home visits Office/home visits - home visits Office/home visits - prolonged services Office/home visits - prolonged services IP visits - hospital visits IP visits - hospital visits Office/home visits - prolonged services Office/home visits - prolonged services Miscellaneous medical - other services Miscellaneous medical - other services Miscellaneous medical - other services Office/home visits - care plan oversight Office/home visits - care plan oversight Office/home visits - care plan oversight Office/home visits - care plan oversight Office/home visits - care plan oversight Office/home visits - care plan oversight Office/home visits - care plan oversight Office/home visits - care plan oversight Office/home visits - care plan oversight Well baby exams Well baby exams Physical exams Physical exams Physical exams Physical exams Physical exams Well baby exams Well baby exams Physical exams Physical exams Physical exams

services services services services services services services services services

Continued

Lim et al 10.e17

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

Skin vacc

J AM ACAD DERMATOL

E and M visit

VOLUME jj, NUMBER j

Supplemental Table I. Cont’d

E and M visit

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

to to to to to to to to to to to to to to to to to to to to to to to

Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer

x

99455

Refer to an AMA-licensed code list

x

99456

Refer to an AMA-licensed code list

x x x x x x x x x x

99460 99461 99462 99463 99464 99465 99466 99467 99468 99469

Refer Refer Refer Refer Refer Refer Refer Refer Refer Refer

an an an an an an an an an an

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed AMA-licensed

code code code code code code code code code code code code code code code code code code code code code code code

code code code code code code code code code code

list list list list list list list list list list list list list list list list list list list list list list list

list list list list list list list list list list

Physical exams Physical exams Physical exams Physical exams Physical exams Physical exams Nonstandard benefit - other Nonstandard benefit - other OP psych-alcohol/drug abuse OP psych-alcohol/drug abuse Physical exams Physical exams Physical exams Physical exams Office/home visits - telephonic and e-mail Office/home visits - telephonic and e-mail Office/home visits - telephonic and e-mail Office/home visits - telephonic and e-mail Office/home visits - telephonic and e-mail Office/home visits - telephonic and e-mail Office/home visits - telephonic and e-mail Office/home visits - telephonic and e-mail Nonstandard benefit - basic life and/or disability evaluation services Nonstandard benefit - basic life and/or disability evaluation services Nonstandard benefit - basic life and/or disability evaluation services IP visits - newborn care Well baby exams IP visits - newborn care IP visits - newborn care IP visits - newborn care IP visits - neonatal visits IP visits - critical care services IP visits - critical care services IP visits - neonatal visits IP visits - neonatal visits Continued

n 2017

99396 99397 99401 99402 99403 99404 99406 99407 99408 99409 99411 99412 99420 99429 99441 99442 99443 99444 99446 99447 99448 99449 99450

J AM ACAD DERMATOL

x x x x x x x x x x x x x x x x x x x x x x x

to to to to to to to to to to

an an an an an an an an an an an an an an an an an an an an an an an

Family description

10.e18 Lim et al

Supplemental Table I. Cont’d

Skin vacc

Skin proc

x x x

HCPCS sode

99471 99472 99475 99476 99477 99478 99479 99480 99481 99482 99485 99486 99487 99488 99489 99490 99495 99496 99497 99498 99499 99500 99501 99502 99503 99504 99505 99506 99507 99509 99510 99511 99512 99600 A6021 A6022 A6023

Code description

Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Refer to an AMA-licensed code list Collagen dressing #16 sq in Collagen dressing [16 #48 sq in Collagen dressing [48 sq in

Family description

IP visits - critical care services IP visits - critical care services IP visits - critical care services IP visits - critical care services IP visits - neonatal visits IP visits - neonatal visits IP visits - neonatal visits IP visits - neonatal visits IP visits - neonatal visits IP visits - neonatal visits IP visits - critical care services IP visits - critical care services Office/home visits - care plan Office/home visits - care plan Office/home visits - care plan Office/home visits - care plan Office/home visits - care plan Office/home visits - care plan Office/home visits - care plan Office/home visits - care plan Office/home visits - care plan PDN/HH PDN/HH PDN/HH PDN/HH PDN/HH PDN/HH PDN/HH PDN/HH PDN/HH PDN/HH PDN/HH PDN/HH PDN/HH DME DME DME

oversight oversight oversight oversight oversight oversight oversight oversight oversight

services services services services services services services services services

Continued

Lim et al 10.e19

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

Proc type

J AM ACAD DERMATOL

E and M visit

VOLUME jj, NUMBER j

Supplemental Table I. Cont’d

E and M visit

Skin vacc

Skin proc

Proc type

HCPCS sode

Code description

Low-cost skin substitute app

x

C5272

Low-cost skin substitute app

x

C5273

Low-cost skin substitute app

x

C5274

Low-cost skin substitute app

x

C5275

Low-cost skin substitute app

x

C5276

Low-cost skin substitute app

x

C5277

Low-cost skin substitute app

x

C5278

Low-cost skin substitute app

x x x x x x x x x x x x x

C9349 C9354 C9358 C9360 C9363 C9364 C9366 C9367 C9368 C9369 C9800 G0127 G0168

Fortaderm, fortaderm antimic Veritas collagen matrix, cm2 SurgiMend, fetal SurgiMend, neonatal Integra Meshed Bil Wound Mat Porcine implant, Permacol EpiFix wound cover Endoform dermal template Grafix core Grafix prime Dermal filler inj px/suppl Trim nail(s) Wound closure by adhesive

x x x x x x x x

G0247 G0429 Q4100 Q4101 Q4102 Q4103 Q4104 Q4105

Routine foot care pt w lops Dermal filler injection(s) Skin substitute, NOS Apligraf Oasis wound matrix Oasis burn matrix Integra Bilayer Matrix Wound Dressing Integra Dermal Regeneration Template

Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of trunk/arms/legs Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of trunk/arms/legs Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of trunk/arms/legs Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of trunk/arms/legs Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of face, etc Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of face, etc Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of face, etc Surgery - integumentary system - grafts - allograft/tissue cultured allogeneic skin substitute - skin of face, etc Prosthetics DME Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Surgery - integumentary system - epidermal introduction - skin Surgery - integumentary system - paring or curettement - nails Surgery - integumentary system - repair/closure of wounds simple - skin Miscellaneous medical - other services Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Continued

n 2017

C5271

J AM ACAD DERMATOL

x

Family description

10.e20 Lim et al

Supplemental Table I. Cont’d

Skin vacc

Skin proc

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

Proc type

HCPCS sode

Q4106 Q4107 Q4108 Q4110 Q4111 Q4112 Q4113 Q4114 Q4115 Q4116 Q4117 Q4118 Q4119 Q4120 Q4121 Q4122 Q4123 Q4124 Q4125 Q4126 Q4127 Q4128 Q4129 Q4130 Q4131 Q4132 Q4133 Q4134 Q4135 Q4136 S0157 S0390

Code description

Dermagraft Graftjacket Integra matrix Primatrix Gammagraft Cymetra injectable Graftjacket Xpress Integra Flowable Wound Matrix Alloskin Alloderm Hyalomatrix Matristem micromatrix Matristem wound matrix Matristem burn matrix Theraskin Dermacell Alloskin Oasis trilayer wound matrix Arthroflex Memoderm/derma/tranz/integup Talymed Flexhd/Allopatchhd/matrixhd Unite biomatrix Strattice TM Epifix Grafix core Grafix prime hMatrix Mediskin EZderm Becaplermin gel 1%, 0.5 g Routine foot care per visit

Family description

Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Prosthetics Nonprescription drugs - nonoral Miscellaneous medical - other services

Lim et al 10.e21

HCPCS codes starting with a number are CPT-4 codes and are property of the American Medical Association (AMA). AMA, American Medical Association; DME, durable medical equipment; ER, emergency room; HH, home health; IP, inpatient; NOS, not otherwise specified; OP, outpatient; PDN, private duty nursing; TM, tissue matrix.

J AM ACAD DERMATOL

E and M visit

VOLUME jj, NUMBER j

Supplemental Table I. Cont’d