Q41 — HCPCS Level II Codes

Q4101 Apligraf, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4102 Oasis wound matrix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4103 Oasis burn matrix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4104 Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4105 Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4107 Graftjacket, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4108 Integra matrix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4110 Primatrix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4111 Gammagraft, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4112 Cymetra, injectable, 1 cc billable
Q4113 Graftjacket xpress, injectable, 1 cc billable
Q4114 Integra flowable wound matrix, injectable, 1 cc billable
Q4115 Alloskin, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4116 Alloderm, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4117 Hyalomatrix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4118 Matristem micromatrix, 1 mg billable
Q4121 Theraskin, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4122 Dermacell, dermacell awm or dermacell awm porous, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4123 Alloskin rt, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4124 Oasis ultra tri-layer wound matrix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4125 Arthroflex, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4126 Memoderm, dermaspan, tranzgraft or integuply, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4127 Talymed, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4128 Flex hd, or allopatch hd, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4130 Strattice tm, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4132 Grafix core and grafixpl core, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4133 Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4134 Hmatrix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4135 Mediskin, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4136 Ez-derm, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4137 Amnioexcel, amnioexcel plus or biodexcel, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4138 Biodfence dryflex, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4139 Amniomatrix or biodmatrix, injectable, 1 cc billable
Q4140 Biodfence, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4141 Alloskin ac, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4142 Xcm biologic tissue matrix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4143 Repriza, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4145 Epifix, injectable, 1 mg billable
Q4146 Tensix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4147 Architect, architect px, or architect fx, extracellular matrix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4148 Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4149 Excellagen, 0.1 cc billable
Q4150 Allowrap ds or dry, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4151 Amnioband or guardian, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4152 Dermapure, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4153 Dermavest and plurivest, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4154 Biovance, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4155 Neoxflo or clarixflo, 1 mg billable
Q4156 Neox 100 or clarix 100, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4157 Revitalon, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4158 Kerecis omega3, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4159 Affinity, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4160 Nushield, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4161 Bio-connekt wound matrix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4162 Woundex flow, bioskin flow, 0.5 cc billable
Q4163 Woundex, bioskin, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4164 Helicoll, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4165 Keramatrix or kerasorb, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4166 Cytal, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4167 Truskin, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4168 Amnioband, 1 mg billable
Q4169 Artacent wound, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4170 Cygnus, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4171 Interfyl, 1 mg billable
Q4173 Palingen or palingen xplus, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4174 Palingen or promatrx, 0.36 mg per 0.25 cc billable
Q4175 Miroderm, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4176 Neopatch or therion, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4177 Floweramnioflo, 0.1 cc billable
Q4178 Floweramniopatch, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4179 Flowerderm, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4180 Revita, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4181 Amnio wound, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4182 Transcyte, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4183 Surgigraft, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4184 Cellesta or cellesta duo, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4185 Cellesta flowable amnion (25 mg per cc); per 0.5 cc billable
Q4186 Epifix, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4187 Epicord, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4188 Amnioarmor, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4189 Artacent ac, 1 mg billable
Q4190 Artacent ac, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4191 Restorigin, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4192 Restorigin, 1 cc billable
Q4193 Coll-e-derm, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4194 Novachor, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4195 Puraply, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4196 Puraply am, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4197 Puraply xt, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4198 Genesis amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure) billable
Q4199 Cygnus matrix, per square centimeter (add-on, list separately in addition to primary procedure) billable