HCPCS Level II › C codes C9358 Surgimend, fetalDermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 800 units per day (clinical), rationale: Clinical: Data Outpatient hospital: max 800 units per day (clinical), rationale: Clinical: Data Payer policies and prior authorization for C9358 20 of 20 payer prior-auth lists that name C9358 require prior authorization or set conditions: Blue Shield of California, CarePlus Health Plans, Cigna, Humana, Rocky Mountain Health Plans.
Payer Plan State Prior auth Conditions Since Source Blue Shield of California Blue Shield Medicare CA prior auth required Sep 1, 2026 Prior Authorization List for Blue Shield Medicare Cigna ACA/IFP All prior auth required May be delegated to eviCore for some clients Feb 6, 2012 Master Precertification List (For Health Care Providers) Cigna Basic Standard All prior auth required May be delegated to eviCore for some clients Feb 6, 2012 Master Precertification List (For Health Care Providers) Cigna Complete/PHS+/Preferred All prior auth required May be delegated to eviCore for some clients Feb 6, 2012 Master Precertification List (For Health Care Providers) Cigna Other Services All prior auth required Experimental/investigational Mar 7, 2026 Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs Cigna Other Services All prior auth required Experimental/investigational Mar 7, 2026 Cigna Commercial Prior Authorization Procedure Code List: Other Services CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana Healthy Horizons IN prior auth required Jan 1, 2027 1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a Humana Humana Healthy Horizons VA prior auth required Jan 1, 2027 Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management Rocky Mountain Health Plans Rocky Mountain Health Plans CHP+ CO prior auth required Oct 1, 2026 Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026 Rocky Mountain Health Plans Rocky Mountain Medicare Advantage D-SNP CO prior auth required Feb 1, 2025 Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
Payer coverage policies that name C9358 C9358 appears in 12 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence.
Payer Policy Role in policy Reviewed Document Aetna Breast Reconstructive Surgery (0185) covered if criteria are met Apr 22, 2026 payer document Aetna Skin and Soft Tissue Substitutes (0244) not covered Jul 29, 2026 payer document Anthem Products for Wound Healing and Soft Tissue Grafting: Medically Necessary Uses (CG-SURG-127) covered if criteria are met Aug 13, 2026 payer document Blue Cross & Blue Shield of Mississippi Bioengineered Skin And Soft Tissue Substitutes (A.7.01.113) unproven / investigational payer document Blue Cross Blue Shield of Massachusetts Bioengineered Skin and Soft Tissue Substitutes (663)Procedure unproven / investigational payer document Blue Cross NC Skin and Soft Tissue Substitutes listed, no stance Aug 1, 2026 payer document Centene Skin and Soft Tissue Substitutes (CP.MP.185) not covered Apr 1, 2026 payer document Cigna Breast Reconstruction Following Mastectomy or Lumpectomy (0178) unproven / investigational Apr 15, 2026 payer document Cigna Tissue-Engineered Skin Substitutes (0068) unproven / investigational Jun 15, 2026 payer document Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) Bioengineered Skin and Soft Tissue Substitutes (SUR704.012)HCPCS Codes A2002, A2004, A2005, A2006, A2007, A2008, A2009, A2010, A2011, listed, no stance Jul 1, 2026 payer document Premera Blue Cross Bioengineered Skin and Soft Tissue Substitutes (7.01.582)Page | 8 of 41 | ∞ unproven / investigational Oct 1, 2026 payer document Regence Bioengineered Skin and Soft Tissue Substitutes and Amniotic Products (Medicine 170) listed, no stance Jun 1, 2026 payer document
Recent prior-auth changes Jan 1, 2027: PA added, Humana Mar 1, 2026: PA removed, Humana Medicaid fee-for-service IN: $11.42 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.