CCSD code S5322 – Keloid scar therapeutic injection

Key takeaways

CCSD Code S5322 covers the injection of a therapeutic substance into a keloid scar, listed in Chapter 1 under simple procedures.

Bupa lists S5322 with no category or fee, and other UK insurers set their own fees, so check each insurer’s schedule.

Pair S5322 with WHO ICD-10 L91.0, hypertrophic scar, which includes keloid scar.

Each injection session is billed separately, so record the lesion, agent, dose and response at every visit.

Send S5322 bills electronically through Healthcode, with the insurer’s pre-authorisation number on every claim.

CCSD Code S5322: definition and clinical description

CCSD Code S5322 is the procedure code for injection of therapeutic substance into keloid scar. CCSD stands for Clinical Coding & Schedule Development, and the CCSD Group’s schedule holds the standard procedure codes for UK private healthcare.

Private medical insurers such as Bupa, AXA Health, Aviva and Vitality use CCSD procedure codes to identify the procedure on a bill. Practitioners then send those bills electronically through Healthcode.

The descriptor names a therapeutic substance rather than a single drug. The code therefore covers any injectable agent delivered directly into the keloid, provided the record supports the choice of agent and the diagnosis.

• Code type: CCSD procedure code
• Schedule: CCSD (Clinical Coding & Schedule Development), UK private healthcare
• Official descriptor: Injection of therapeutic substance into keloid scar
• Chapter: 1, Simple investigations and procedures (simple procedures)
• Bupa category and fee: none listed
• Primary ICD-10 pairing: L91.0, hypertrophic scar (includes keloid scar)
• Practitioners: dermatologists, plastic surgeons and other doctors who treat keloids

Clinical scope of S5322: what the injection procedure covers

The procedure introduces a therapeutic agent into the body of the keloid through a fine-gauge needle. Overall, the aim is to soften and flatten the scar, ease pain or itching, and reduce the risk of regrowth.

Keloids rarely respond to a single session, so treatment usually runs as a course spaced several weeks apart. Three agents are commonly used, and S5322 covers each of them:

• Triamcinolone acetonide: the corticosteroid most often used for intralesional keloid treatment. Also, record the concentration and volume at every session.
• 5-fluorouracil (5-FU): an antimetabolite used alone or with a steroid, often when steroid side effects such as skin thinning are a concern. Its use in keloids is off-label, so record the clinical rationale.
• Bleomycin: used for keloids that have not responded to other treatment. This use is also off-label, so note the agent, dose and justification.

Whether an insurer pays for the drug as well as the injection depends on its schedule and the patient’s policy. Confirm the position with the insurer before the first session.

Keloid vs hypertrophic scar: why the coding distinction matters

Keloids and hypertrophic scars are both raised scars caused by abnormal wound healing. A keloid grows beyond the original wound into surrounding skin and rarely regresses. In contrast, a hypertrophic scar stays within the wound margins and often flattens with time.

However, the diagnosis code cannot separate them. WHO ICD-10 L91.0 is headed hypertrophic scar and includes keloid scar, so both conditions share one code. The S5322 descriptor names a keloid, so your clinical notes have to show that the scar is one.

Describe the lesion so that it confirms its keloid features. For example, note growth beyond the wound margin, firmness, symptoms such as pain or itching, and how long it has been present. That record supports the S5322 claim and also answers a cosmetic exclusion query.

ICD-10 diagnosis codes to pair with CCSD Code S5322

However, UK insurers expect a diagnosis from the WHO ICD-10 classification, not the US ICD-10-CM. L91.0 is the correct primary pairing for S5322, because it includes keloid scar.

Check the insurer’s own guidance if it maps diagnoses to procedures. A mismatch between the procedure and the diagnosis is also a common reason for a query.

Related CCSD codes commonly confused with S5322

Several neighbouring codes cover nearby work on the skin. The descriptors, categories and fees below come from the Bupa CCSD schedule (February 2026), which our guide to Bupa CCSD codes covers. Other insurers set different fees.

Documentation requirements for S5322 claims

Insurers can query an S5322 claim, but a thin procedure note is the most avoidable cause. In short, the record must show that the procedure took place, that the diagnosis warrants it, and why you chose the agent.

At a minimum, the procedure note for each S5322 session should include:

• Confirmed diagnosis: record the keloid diagnosis with its clinical features, such as growth beyond the wound margin, firmness, pain or itching, and duration.
• Lesion details: location, size in millimetres and the number of lesions injected. Document each lesion separately when you inject more than one.
• Therapeutic agent: name, concentration and volume injected. For 5-FU or bleomycin, add the clinical rationale.
• Injection technique: note that the injection was intralesional.
• Clinical response: record changes since the last session, such as reduced volume or symptom relief, or the lack of response that justifies continuing.
• Patient consent: record that the patient understood the procedure, expected outcomes and possible side effects.

A digital clinical form with required fields captures these details at the point of care. When the insurer reviews the claim, the note already holds the agent, dose and lesion size it asks for.

Reimbursement and fees for S5322

For example, the Bupa schedule lists S5322 under simple procedures with no category and no fee. There is no single UK fee for the code, because each insurer sets its own.

Published insurer fees differ. Other insurers set their own fees for S5322, so check each insurer’s current schedule before you quote a patient.

If your charge is above the insurer’s fee, the patient may face a shortfall. Explain the difference in writing before treatment so the balance is agreed in advance.

Insurer pre-authorisation and cosmetic vs medical necessity

However, insurer cover for S5322 is not automatic. Most UK private medical insurers expect the patient to obtain pre-authorisation before treatment. Record the authorisation number before the first session.

Above all, the cosmetic question is the biggest reimbursement risk. Many policies exclude cosmetic treatment, so cover for keloid injection often depends on symptoms such as pain, itching or restricted movement. Cover varies by insurer and policy, so confirm it before the first claim.

When medical necessity is in question, support the claim with:

• Supporting letter: written by the treating practitioner, stating the diagnosis, the effect on the patient, the treatment plan and the expected outcome.
• Clinical photographs: some insurers ask for before and after photographs at renewal. Use consistent lighting and a scale so that sessions can be compared.
• Referral letter: if a GP or another specialist referred the patient, include the referral.

Billing for repeat S5322 injections on the same keloid lesion

Intralesional keloid treatment rarely succeeds after one session. Therefore, each session is billed separately under S5322, provided the record supports the decision to continue.

Three documentation points matter for repeat sessions:

• Justify each session on its own: record the lesion’s size, firmness and symptoms at each visit, and why treatment continues. A note that the patient returned for injection is not enough.
• Track the course: note the session number and how long treatment has run. Insurers may ask for the full history when they review a later claim.
• Renew pre-authorisation: an insurer may authorise a set number of sessions. Ask for further authorisation, with updated notes, before you treat beyond that number.

Common S5322 claim denial reasons (and how to prevent them)

Insurer queries on S5322 follow a consistent pattern. In fact, most are preventable with the right documentation and billing workflow.

How to record and submit S5322 claims

Therefore, a structured workflow for S5322 cuts coding errors and speeds up payment. The steps below suit UK private dermatology and aesthetic practices billing insurers through Healthcode.

1. Record the diagnosis at the point of care. Enter L91.0 in the patient record and describe the keloid’s features before you close the consultation.
2. Enter S5322 as the procedure code. Confirm the descriptor reads injection of therapeutic substance into keloid scar, so you don’t pick S5300 by mistake.
3. Link the diagnosis to the procedure line. Pair L91.0 with the S5322 line so the insurer sees a matching diagnosis and procedure.
4. Record the authorisation number. Enter the insurer’s pre-authorisation reference on the bill. A missing number is also a common reason for a rejected bill.
5. Submit through Healthcode. Send the bill electronically to the insurer and keep the submission confirmation.
6. Reconcile the payment. Match the insurer’s remittance to the bill and invoice the patient for any agreed shortfall.

How Pabau keeps S5322 claims clean

Pabau, the practice management platform we build, keeps the procedure note, consent form and invoice on one patient record. The practitioner documents each session once, and the billing team works from the same record.

In addition, Pabau’s claims management software sends UK insurer bills through Healthcode and tracks what comes back. Each session of a keloid injection course sits on the same record, so the history is there when an insurer asks for it.

Manage CCSD billing from one place

Pabau keeps the procedure note, consent forms and invoice in one patient record, and submits UK insurer bills through Healthcode. See how it works for your practice.

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Conclusion

S5322 is a narrow code. It covers an injection into a keloid scar and no wider procedure, so its claims rise or fall on the record behind them.

The diagnosis code cannot tell a keloid from a hypertrophic scar, so the procedure note has to. Put the keloid’s features, the agent and the dose in every note, and check each insurer’s fee before you quote. Ultimately, that record is what keeps a course of injections paid.

To see how Pabau builds that record into every consultation, book a demo.

Continue your research

Looking for broader CCSD billing guidance? Bupa CCSD codes explains how the schedule works across UK private healthcare billing.

Billing another Chapter 1 simple procedure? CCSD code 25000 covers incision and drainage not elsewhere covered.

Confirming the diagnosis with a biopsy first? CCSD code S1500 covers biopsy of skin or subcutaneous tissue.

Looking up another UK private insurance code? The CCSD codes library lists every code guide we publish for UK private practice.

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