Codify By AAPC
HCPCS Range Skin Substitutes and Biologicals
1
"Grafix CORE and GrafixPL CORE, per square centimeter ( Q4132 )
2
Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter ( Q4133 )
3
Skin substitute, not otherwise specified ( Q4100 )
4
Apligraf, per square centimeter ( Q4101 )
5
Oasis wound matrix, per square centimeter ( Q4102 )
6
Oasis burn matrix, per square centimeter ( Q4103 )
7
Integra bilayer matrix wound dressing (BMWD), per square centimeter ( Q4104 )
8
Integra dermal regeneration template (DRT) or integra omnigraft dermal regeneration matrix, per square centimeter ( Q4105 )
9
Dermagraft, per square centimeter ( Q4106 )
10
GRAFTJACKET, per square centimeter ( Q4107 )
11
Integra matrix, per square centimeter ( Q4108 )
12
PriMatrix, per square centimeter ( Q4110 )
13
GammaGraft, per square centimeter ( Q4111 )
14
Cymetra, injectable, 1cc ( Q4112 )
15
GRAFTJACKET XPRESS, injectable, 1cc ( Q4113 )
16
Integra flowable wound matrix, injectable, 1cc ( Q4114 )
17
AlloSkin, per square centimeter ( Q4115 )
18
AlloDerm, per square centimeter ( Q4116 )
19
HYALOMATRIX, per square centimeter ( Q4117 )
20
MatriStem micromatrix, 1 mg ( Q4118 )
21
TheraSkin, per square centimeter ( Q4121 )
22
Dermacell, dermacell awm or dermacell awm porous, per square centimeter ( Q4122 )
23
AlloSkin RT, per square centimeter ( Q4123 )
24
OASIS ultra tri-layer wound matrix, per square centimeter ( Q4124 )
25
Arthroflex, per square centimeter ( Q4125 )
26
MemoDerm, DermaSpan, TranZgraft or InteguPly, per square centimeter ( Q4126 )
27
Talymed, per square centimeter ( Q4127 )
28
Flex hd, or allopatch hd, per square centimeter ( Q4128 )
29
Strattice TM, per square centimeter ( Q4130 )
30
Hmatrix, per square centimeter ( Q4134 )
31
Mediskin, per square centimeter ( Q4135 )
32
E-Z Derm, per square centimeter ( Q4136 )
33
Amnioexcel, amnioexcel plus or biodexcel, per square centimeter ( Q4137 )
34
BioDFence dryflex, per square centimeter ( Q4138 )
35
AmnioMatrix or biodmatrix, injectable, 1 cc ( Q4139 )
36
Biodfence, per square centimeter ( Q4140 )
37
AlloSkin AC, per square centimeter ( Q4141 )
38
XCM BIOLOGIC tissue matrix, per square centimeter ( Q4142 )
39
Repriza, per square centimeter ( Q4143 )
40
EpiFix, injectable, 1 mg ( Q4145 )
41
Tensix, per square centimeter ( Q4146 )
42
Architect, Architect PX, or Architect FX, extracellular matrix, per square centimeter ( Q4147 )
43
Excellagen, 0.1 cc ( Q4149 )
44
Bio-ConneKt wound matrix, per square centimeter ( Q4161 )
45
Allowrap DS or Dry, per square centimeter ( Q4150 )
46
AmnioBand or Guardian, per square centimeter ( Q4151 )
47
DermaPure, per square centimeter ( Q4152 )
48
Dermavest and plurivest, per square centimeter ( Q4153 )
49
Biovance, per square centimeter ( Q4154 )
50
NeoxFlo or clarixFlo, 1 mg ( Q4155 )
51
Revitalon, per square centimeter ( Q4157 )
52
Affinity, per square centimeter ( Q4159 )
53
NuShield, per square centimeter ( Q4160 )
54
Helicoll, per square centimeter ( Q4164 )
55
Keramatrix or kerasorb, per square centimeter ( Q4165 )
56
Cytal, per square centimeter ( Q4166 )
57
Truskin, per square centimeter ( Q4167 )
58
Amnioband, 1 mg ( Q4168 )
59
Artacent wound, per square centimeter ( Q4169 )
60
Cygnus, per square centimeter ( Q4170 )
61
Interfyl, 1 mg ( Q4171 )
62
Palingen or palingen xplus, per square centimeter ( Q4173 )
63
Palingen or promatrx, 0.36 mg per 0.25 cc ( Q4174 )
64
Miroderm, per square centimeter ( Q4175 )
65
Neopatch or therion, per square centimeter ( Q4176 )
66
Floweramnioflo, 0.1 cc ( Q4177 )
67
Floweramniopatch, per square centimeter ( Q4178 )
68
Flowerderm, per square centimeter ( Q4179 )
69
Revita, per square centimeter ( Q4180 )
70
Amnio wound, per square centimeter ( Q4181 )
71
Transcyte, per square centimeter ( Q4182 )
72
NEOX CORD 1K, NEOX CORD RT, or CLARIX CORD 1K, per square centimeter ( Q4148 )
73
NEOX 100 or CLARIX 100, per square centimeter ( Q4156 )
74
Kerecis Omega3, per square centimeter ( Q4158 )
75
WoundEx Flow, BioSkin Flow, 0.5 cc ( Q4162 )
76
WoundEx, BioSkin, per square centimeter ( Q4163 )
77
Surgigraft, per square centimeter ( Q4183 )
78
Cellesta or cellesta duo, per square centimeter ( Q4184 )
79
Cellesta flowable amnion (25 mg per cc); per 0.5 cc ( Q4185 )
80
Epifix, per square centimeter ( Q4186 )
81
Epicord, per square centimeter ( Q4187 )
82
Amnioarmor, per square centimeter ( Q4188 )
83
Artacent ac, 1 mg ( Q4189 )
84
Artacent ac, per square centimeter ( Q4190 )
85
Restorigin, per square centimeter ( Q4191 )
86
Restorigin, 1 cc ( Q4192 )
87
Coll-e-derm, per square centimeter ( Q4193 )
88
Novachor, per square centimeter ( Q4194 )
89
Puraply, per square centimeter ( Q4195 )
90
Puraply am, per square centimeter ( Q4196 )
91
Puraply xt, per square centimeter ( Q4197 )
92
Genesis amniotic membrane, per square centimeter ( Q4198 )
93
Skin te, per square centimeter ( Q4200 )
94
Matrion, per square centimeter ( Q4201 )
95
Keroxx (2.5g/cc), 1cc ( Q4202 )
96
Derma-gide, per square centimeter ( Q4203 )
97
Xwrap, per square centimeter ( Q4204 )
98
Amnion bio or Axobiomembrane, per square centimeter ( Q4211 )
99
Novafix, per square cenitmeter ( Q4208 )
100
Surgraft, per square centimeter ( Q4209 )
101
Membrane graft or membrane wrap, per square centimeter ( Q4205 )
102
Fluid flow or fluid GF, 1 cc ( Q4206 )
103
BellaCell HD or Surederm, per square centimeter ( Q4220 )
104
Axolotl graft or axolotl dualgraft, per square centimeter ( Q4210 )
105
Axolotl ambient or axolotl cryo, 0.1 mg ( Q4215 )
106
Artacent cord, per square centimeter ( Q4216 )
107
Progenamatrix, per square centimeter ( Q4222 )
108
Allogen, per cc ( Q4212 )
109
Ascent, 0.5 mg ( Q4213 )
110
Cellesta cord, per square centimeter ( Q4214 )
111
MyOwn skin, includes harvesting and preparation procedures, per square centimeter ( Q4226 )
112
Woundfix, BioWound, Woundfix Plus, BioWound Plus, Woundfix Xplus or BioWound Xplus, per square centimeter ( Q4217 )
113
Surgicord, per square centimeter ( Q4218 )
114
Surgigraft-dual, per square centimeter ( Q4219 )
115
Amniowrap2, per square centimeter ( Q4221 )
116
Amniocore, per square centimeter ( Q4227 )
117
Cogenex amniotic membrane, per square centimeter ( Q4229 )
118
Cogenex flowable amnion, per 0.5 cc ( Q4230 )
119
Corplex p, per cc ( Q4231 )
120
Corplex, per square centimeter ( Q4232 )
121
Surfactor or nudyn, per 0.5 cc ( Q4233 )
122
Xcellerate, per square centimeter ( Q4234 )
123
Amniorepair or altiply, per square centimeter ( Q4235 )
124
Carepatch, per square centimeter ( Q4236 )
125
Cryo-cord, per square centimeter ( Q4237 )
126
Derm-maxx, per square centimeter ( Q4238 )
127
Amnio-maxx or amnio-maxx lite, per square centimeter ( Q4239 )
128
Corecyte, for topical use only, per 0.5 cc ( Q4240 )
129
Polycyte, for topical use only, per 0.5 cc ( Q4241 )
130
Amniocyte plus, per 0.5 cc ( Q4242 )
131
Amniotext, per cc ( Q4245 )
132
Coretext or protext, per cc ( Q4246 )
133
Amniotext patch, per square centimeter ( Q4247 )
134
Dermacyte amniotic membrane allograft, per square centimeter ( Q4248 )
135
Amniply, for topical use only, per square centimeter ( Q4249 )
136
Amnioamp-mp, per square centimeter ( Q4250 )
137
Novafix dl, per square centimeter ( Q4254 )
138
Reguard, for topical use only, per square centimeter ( Q4255 )
139
Vim, per square centimeter ( Q4251 )
140
Vendaje, per square centimeter ( Q4252 )
141
Zenith amniotic membrane, per square centimeter ( Q4253 )
142
Cygnus matrix, per square centimeter ( Q4199 )
143
Human health factor 10 amniotic patch (hhf10-p), per square centimeter ( Q4224 )
144
Amniobind or dermabind tl, per square centimeter ( Q4225 )
145
Mlg-complete, per square centimeter ( Q4256 )
146
Relese, per square centimeter ( Q4257 )
147
Enverse, per square centimeter ( Q4258 )
148
Celera dual layer or celera dual membrane, per square centimeter ( Q4259 )
149
Signature apatch, per square centimeter ( Q4260 )
150
Tag, per square centimeter ( Q4261 )
151
Dual layer impax membrane, per square centimeter ( Q4262 )
152
Surgraft tl, per square centimeter ( Q4263 )
153
Cocoon membrane, per square centimeter ( Q4264 )
154
Neostim tl, per square centimeter ( Q4265 )
155
Neostim membrane, per square centimeter ( Q4266 )
156
Neostim dl, per square centimeter ( Q4267 )
157
Surgraft ft, per square centimeter ( Q4268 )
158
Surgraft xt, per square centimeter ( Q4269 )
159
Complete sl, per square centimeter ( Q4270 )
160
Complete ft, per square centimeter ( Q4271 )
161
Esano a, per square centimeter ( Q4272 )
162
Esano aaa, per square centimeter ( Q4273 )
163
Esano ac, per square centimeter ( Q4274 )
164
Esano aca, per square centimeter ( Q4275 )
165
Orion, per square centimeter ( Q4276 )
166
Woundplus membrane or e-graft, per square centimeter ( Q4277 )
167
Epieffect, per square centimeter ( Q4278 )
168
Xcell amnio matrix, per square centimeter ( Q4280 )
169
Barrera sl or barrera dl, per square centimeter ( Q4281 )
170
Cygnus dual, per square centimeter ( Q4282 )
171
Biovance tri-layer or biovance 3l, per square centimeter ( Q4283 )
172
Dermabind sl, per square centimeter ( Q4284 )
173
Nudyn dl or nudyn dl mesh, per square centimeter ( Q4285 )
174
Nudyn sl or nudyn slw, per square centimeter ( Q4286 )
175
Vendaje ac, per square centimeter ( Q4279 )
176
Dermabind dl, per square centimeter ( Q4287 )
177
Dermabind ch, per square centimeter ( Q4288 )
178
Revoshield + amniotic barrier, per square centimeter ( Q4289 )
179
Membrane wrap-hydro, per square centimeter ( Q4290 )
180
Lamellas xt, per square centimeter ( Q4291 )
181
Lamellas, per square centimeter ( Q4292 )
182
Acesso dl, per square centimeter ( Q4293 )
183
Amnio quad-core, per square centimeter ( Q4294 )
184
Amnio tri-core amniotic, per square centimeter ( Q4295 )
185
Rebound matrix, per square centimeter ( Q4296 )
186
Emerge matrix, per square centimeter ( Q4297 )
187
Amniocore pro, per square centimeter ( Q4298 )
188
Amniocore pro+, per square centimeter ( Q4299 )
189
Acesso tl, per square centimeter ( Q4300 )
190
Activate matrix, per square centimeter ( Q4301 )
191
Complete aca, per square centimeter ( Q4302 )
192
Complete aa, per square centimeter ( Q4303 )
193
Grafix plus, per square centimeter ( Q4304 )
194
American amnion ac tri-layer, per square centimeter ( Q4305 )
195
American amnion ac, per square centimeter ( Q4306 )
196
American amnion, per square centimeter ( Q4307 )
197
Sanopellis, per square centimeter ( Q4308 )
198
Via matrix, per square centimeter ( Q4309 )
199
Procenta, per 100 mg ( Q4310 )