Q4410 Amchomatrixdl, per square centimeter (add-on, list separately in addition to primary procedure)

BackQ4001Casting supplies, body cast adult, with or without head, plasterQ4002Cast supplies, body cast adult, with or without head, fiberglassQ4003Cast supplies, shoulder cast, adult (11 years +), plasterQ4004Cast supplies, shoulder cast, adult (11 years +), fiberglassQ4005Cast supplies, long arm cast, adult (11 years +), plasterQ4006Cast supplies, long arm cast, adult (11 years +), fiberglassQ4007Cast supplies, long arm cast, pediatric (0-10 years), plasterQ4008Cast supplies, long arm cast, pediatric (0-10 years), fiberglassQ4009Cast supplies, short arm cast, adult (11 years +), plasterQ4010Cast supplies, short arm cast, adult (11 years +), fiberglassQ4011Cast supplies, short arm cast, pediatric (0-10 years), plasterQ4012Cast supplies, short arm cast, pediatric (0-10 years), fiberglassQ4013Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plasterQ4014Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglassQ4015Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plasterQ4016Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglassQ4017Cast supplies, long arm splint, adult (11 years +), plasterQ4018Cast supplies, long arm splint, adult (11 years +), fiberglassQ4019Cast supplies, long arm splint, pediatric (0-10 years), plasterQ4020Cast supplies, long arm splint, pediatric (0-10 years), fiberglassQ4021Cast supplies, short arm splint, adult (11 years +), plasterQ4022Cast supplies, short arm splint, adult (11 years +), fiberglassQ4023Cast supplies, short arm splint, pediatric (0-10 years), plasterQ4024Cast supplies, short arm splint, pediatric (0-10 years), fiberglassQ4025Cast supplies, hip spica (one or both legs), adult (11 years +), plasterQ4026Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglassQ4027Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plasterQ4028Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglassQ4029Cast supplies, long leg cast, adult (11 years +), plasterQ4030Cast supplies, long leg cast, adult (11 years +), fiberglassQ4031Cast supplies, long leg cast, pediatric (0-10 years), plasterQ4032Cast supplies, long leg cast, pediatric (0-10 years), fiberglassQ4033Cast supplies, long leg cylinder cast, adult (11 years +), plasterQ4034Cast supplies, long leg cylinder cast, adult (11 years +), fiberglassQ4035Cast supplies, long leg cylinder cast, pediatric (0-10 years), plasterQ4036Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglassQ4037Cast supplies, short leg cast, adult (11 years +), plasterQ4038Cast supplies, short leg cast, adult (11 years +), fiberglassQ4039Cast supplies, short leg cast, pediatric (0-10 years), plasterQ4040Cast supplies, short leg cast, pediatric (0-10 years), fiberglassQ4041Cast supplies, long leg splint, adult (11 years +), plasterQ4042Cast supplies, long leg splint, adult (11 years +), fiberglassQ4043Cast supplies, long leg splint, pediatric (0-10 years), plasterQ4044Cast supplies, long leg splint, pediatric (0-10 years), fiberglassQ4045Cast supplies, short leg splint, adult (11 years +), plasterQ4046Cast supplies, short leg splint, adult (11 years +), fiberglassQ4047Cast supplies, short leg splint, pediatric (0-10 years), plasterQ4048Cast supplies, short leg splint, pediatric (0-10 years), fiberglassQ4049Finger splint, staticQ4050Cast supplies, for unlisted types and materials of castsQ4051Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies)Q4074Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 microgramsQ4081Injection, epoetin alfa, 100 units (for esrd on dialysis)Q4082Drug or biological, not otherwise classified, part b drug competitive acquisition program (cap)Q4101Apligraf, per square centimeter (add-on, list separately in addition to primary procedure)Q4102Oasis wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4103Oasis burn matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4104Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure)Q4105Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4107Graftjacket, per square centimeter (add-on, list separately in addition to primary procedure)Q4108Integra matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4110Primatrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4111Gammagraft, per square centimeter (add-on, list separately in addition to primary procedure)Q4112Cymetra, injectable, 1 ccQ4113Graftjacket xpress, injectable, 1 ccQ4114Integra flowable wound matrix, injectable, 1 ccQ4115Alloskin, per square centimeter (add-on, list separately in addition to primary procedure)Q4116Alloderm, per square centimeter (add-on, list separately in addition to primary procedure)Q4117Hyalomatrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4118Matristem micromatrix, 1 mgQ4121Theraskin, per square centimeter (add-on, list separately in addition to primary procedure)Q4122Dermacell, dermacell awm or dermacell awm porous, per square centimeter (add-on, list separately in addition to primary procedure)Q4123Alloskin rt, per square centimeter (add-on, list separately in addition to primary procedure)Q4124Oasis ultra tri-layer wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4125Arthroflex, per square centimeter (add-on, list separately in addition to primary procedure)Q4126Memoderm, dermaspan, tranzgraft or integuply, per square centimeter (add-on, list separately in addition to primary procedure)Q4127Talymed, per square centimeter (add-on, list separately in addition to primary procedure)Q4128Flex hd, or allopatch hd, per square centimeter (add-on, list separately in addition to primary procedure)Q4130Strattice tm, per square centimeter (add-on, list separately in addition to primary procedure)Q4132Grafix core and grafixpl core, per square centimeter (add-on, list separately in addition to primary procedure)Q4133Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter (add-on, list separately in addition to primary procedure)Q4134Hmatrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4135Mediskin, per square centimeter (add-on, list separately in addition to primary procedure)Q4136Ez-derm, per square centimeter (add-on, list separately in addition to primary procedure)Q4137Amnioexcel, amnioexcel plus or biodexcel, per square centimeter (add-on, list separately in addition to primary procedure)Q4138Biodfence dryflex, per square centimeter (add-on, list separately in addition to primary procedure)Q4139Amniomatrix or biodmatrix, injectable, 1 ccQ4140Biodfence, per square centimeter (add-on, list separately in addition to primary procedure)Q4141Alloskin ac, per square centimeter (add-on, list separately in addition to primary procedure)Q4142Xcm biologic tissue matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4143Repriza, per square centimeter (add-on, list separately in addition to primary procedure)Q4145Epifix, injectable, 1 mgQ4146Tensix, per square centimeter (add-on, list separately in addition to primary procedure)Q4147Architect, architect px, or architect fx, extracellular matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4148Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter (add-on, list separately in addition to primary procedure)Q4149Excellagen, 0.1 ccQ4150Allowrap ds or dry, per square centimeter (add-on, list separately in addition to primary procedure)Q4151Amnioband or guardian, per square centimeter (add-on, list separately in addition to primary procedure)Q4152Dermapure, per square centimeter (add-on, list separately in addition to primary procedure)Q4153Dermavest and plurivest, per square centimeter (add-on, list separately in addition to primary procedure)Q4154Biovance, per square centimeter (add-on, list separately in addition to primary procedure)Q4155Neoxflo or clarixflo, 1 mgQ4156Neox 100 or clarix 100, per square centimeter (add-on, list separately in addition to primary procedure)Q4157Revitalon, per square centimeter (add-on, list separately in addition to primary procedure)Q4158Kerecis omega3, per square centimeter (add-on, list separately in addition to primary procedure)Q4159Affinity, per square centimeter (add-on, list separately in addition to primary procedure)Q4160Nushield, per square centimeter (add-on, list separately in addition to primary procedure)Q4161Bio-connekt wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4162Woundex flow, bioskin flow, 0.5 ccQ4163Woundex, bioskin, per square centimeter (add-on, list separately in addition to primary procedure)Q4164Helicoll, per square centimeter (add-on, list separately in addition to primary procedure)Q4165Keramatrix or kerasorb, per square centimeter (add-on, list separately in addition to primary procedure)Q4166Cytal, per square centimeter (add-on, list separately in addition to primary procedure)Q4167Truskin, per square centimeter (add-on, list separately in addition to primary procedure)Q4168Amnioband, 1 mgQ4169Artacent wound, per square centimeter (add-on, list separately in addition to primary procedure)Q4170Cygnus, per square centimeter (add-on, list separately in addition to primary procedure)Q4171Interfyl, 1 mgQ4173Palingen or palingen xplus, per square centimeter (add-on, list separately in addition to primary procedure)Q4174Palingen or promatrx, 0.36 mg per 0.25 ccQ4175Miroderm, per square centimeter (add-on, list separately in addition to primary procedure)Q4176Neopatch or therion, per square centimeter (add-on, list separately in addition to primary procedure)Q4177Floweramnioflo, 0.1 ccQ4178Floweramniopatch, per square centimeter (add-on, list separately in addition to primary procedure)Q4179Flowerderm, per square centimeter (add-on, list separately in addition to primary procedure)Q4180Revita, per square centimeter (add-on, list separately in addition to primary procedure)Q4181Amnio wound, per square centimeter (add-on, list separately in addition to primary procedure)Q4182Transcyte, per square centimeter (add-on, list separately in addition to primary procedure)Q4183Surgigraft, per square centimeter (add-on, list separately in addition to primary procedure)Q4184Cellesta or cellesta duo, per square centimeter (add-on, list separately in addition to primary procedure)Q4185Cellesta flowable amnion (25 mg per cc); per 0.5 ccQ4186Epifix, per square centimeter (add-on, list separately in addition to primary procedure)Q4187Epicord, per square centimeter (add-on, list separately in addition to primary procedure)Q4188Amnioarmor, per square centimeter (add-on, list separately in addition to primary procedure)Q4189Artacent ac, 1 mgQ4190Artacent ac, per square centimeter (add-on, list separately in addition to primary procedure)Q4191Restorigin, per square centimeter (add-on, list separately in addition to primary procedure)Q4192Restorigin, 1 ccQ4193Coll-e-derm, per square centimeter (add-on, list separately in addition to primary procedure)Q4194Novachor, per square centimeter (add-on, list separately in addition to primary procedure)Q4195Puraply, per square centimeter (add-on, list separately in addition to primary procedure)Q4196Puraply am, per square centimeter (add-on, list separately in addition to primary procedure)Q4197Puraply xt, per square centimeter (add-on, list separately in addition to primary procedure)Q4198Genesis amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4199Cygnus matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4200Skin te, per square centimeter (add-on, list separately in addition to primary procedure)Q4201Matrion, per square centimeter (add-on, list separately in addition to primary procedure)Q4202Keroxx (2.5g/cc), 1ccQ4203Derma-gide, per square centimeter (add-on, list separately in addition to primary procedure)Q4204Xwrap, per square centimeter (add-on, list separately in addition to primary procedure)Q4205Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)Q4206Fluid flow or fluid gf, 1 ccQ4207Carbon life, per square centimeter (add-on, list separately in addition to primary procedure)Q4208Novafix, per square cenitmeter (add-on, list separately in addition to primary procedure)Q4209Surgraft, per square centimeter (add-on, list separately in addition to primary procedure)Q4211Amnion bio or axobiomembrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4212Allogen, per ccQ4213Ascent, 0.5 mgQ4214Cellesta cord, per square centimeter (add-on, list separately in addition to primary procedure)Q4215Axolotl ambient or axolotl cryo, 0.1 mgQ4216Artacent cord, per square centimeter (add-on, list separately in addition to primary procedure)Q4217Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter (add-on, list separately in addition to primary procedure)Q4218Surgicord, per square centimeter (add-on, list separately in addition to primary procedure)Q4219Surgigraft-dual, per square centimeter (add-on, list separately in addition to primary procedure)Q4220Bellacell hd or surederm, per square centimeter (add-on, list separately in addition to primary procedure)Q4221Amniowrap2, per square centimeter (add-on, list separately in addition to primary procedure)Q4222Progenamatrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4223Dermabind sl optic, per square centimeter (add-on, list separately in addition to primary procedure)Q4224Human health factor 10 amniotic patch (hhf10-p), per square centimeter (add-on, list separately in addition to primary procedure)Q4225Amniobind or dermabind tl, per square centimeter (add-on, list separately in addition to primary procedure)Q4226Myown skin, includes harvesting and preparation procedures, per square centimeterQ4227Amniocore, per square centimeter (add-on, list separately in addition to primary procedure)Q4229Cogenex amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4230Cogenex flowable amnion, per 0.5 ccQ4232Corplex, per square centimeter (add-on, list separately in addition to primary procedure)Q4233Surfactor or nudyn, per 0.5 ccQ4234Xcellerate, per square centimeter (add-on, list separately in addition to primary procedure)Q4235Amniorepair or altiply, per square centimeter (add-on, list separately in addition to primary procedure)Q4236Carepatch, per square centimeter (add-on, list separately in addition to primary procedure)Q4237Cryo-cord, per square centimeter (add-on, list separately in addition to primary procedure)Q4238Derm-maxx, per square centimeter (add-on, list separately in addition to primary procedure)Q4239Amnio-maxx or amnio-maxx lite, per square centimeter (add-on, list separately in addition to primary procedure)Q4240Corecyte, for topical use only, per 0.5 ccQ4241Polycyte, for topical use only, per 0.5 ccQ4242Amniocyte plus, per 0.5 ccQ4243Amchomatrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4245Amniotext, per ccQ4246Coretext or protext, per ccQ4247Amniotext patch, per square centimeter (add-on, list separately in addition to primary procedure)Q4248Dermacyte amniotic membrane allograft, per square centimeter (add-on, list separately in addition to primary procedure)Q4249Amniply, for topical use only, per square centimeter (add-on, list separately in addition to primary procedure)Q4250Amnioamp-mp, per square centimeter (add-on, list separately in addition to primary procedure)Q4251Vim, per square centimeter (add-on, list separately in addition to primary procedure)Q4252Vendaje, per square centimeter (add-on, list separately in addition to primary procedure)Q4253Zenith amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4254Novafix dl, per square centimeter (add-on, list separately in addition to primary procedure)Q4255Reguard, for topical use only, per square centimeter (add-on, list separately in addition to primary procedure)Q4256Mlg-complete, per square centimeter (add-on, list separately in addition to primary procedure)Q4257Relese, per square centimeter (add-on, list separately in addition to primary procedure)Q4258Enverse, per square centimeter (add-on, list separately in addition to primary procedure)Q4259Celera dual layer or celera dual membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4260Signature apatch, per square centimeter (add-on, list separately in addition to primary procedure)Q4261Tag, per square centimeter (add-on, list separately in addition to primary procedure)Q4262Dual layer impax membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4263Surgraft tl, per square centimeter (add-on, list separately in addition to primary procedure)Q4264Cocoon membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4265Neostim tl, per square centimeter (add-on, list separately in addition to primary procedure)Q4266Neostim membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4267Neostim dl, per square centimeter (add-on, list separately in addition to primary procedure)Q4268Surgraft ft, per square centimeter (add-on, list separately in addition to primary procedure)Q4269Surgraft xt, per square centimeter (add-on, list separately in addition to primary procedure)Q4270Complete sl, per square centimeter (add-on, list separately in addition to primary procedure)Q4271Complete ft, per square centimeter (add-on, list separately in addition to primary procedure)Q4272Esano a, per square centimeter (add-on, list separately in addition to primary procedure)Q4273Esano aaa, per square centimeter (add-on, list separately in addition to primary procedure)Q4274Esano ac, per square centimeter (add-on, list separately in addition to primary procedure)Q4275Esano aca, per square centimeter (add-on, list separately in addition to primary procedure)Q4276Orion, per square centimeter (add-on, list separately in addition to primary procedure)Q4278Epieffect, per square centimeter (add-on, list separately in addition to primary procedure)Q4279Vendaje ac, per square centimeter (add-on, list separately in addition to primary procedure)Q4280Xcell amnio matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4281Barrera sl or barrera dl, per square centimeter (add-on, list separately in addition to primary procedure)Q4282Cygnus dual, per square centimeter (add-on, list separately in addition to primary procedure)Q4283Biovance tri-layer or biovance 3l, per square centimeter (add-on, list separately in addition to primary procedure)Q4284Dermabind sl, per square centimeter (add-on, list separately in addition to primary procedure)Q4285Nudyn dl or nudyn dl mesh, per square centimeter (add-on, list separately in addition to primary procedure)Q4286Nudyn sl or nudyn slw, per square centimeter (add-on, list separately in addition to primary procedure)Q4287Dermabind dl, per square centimeter (add-on, list separately in addition to primary procedure)Q4288Dermabind ch, per square centimeter (add-on, list separately in addition to primary procedure)Q4289Revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure)Q4290Membrane wrap-hydro, per square centimeter (add-on, list separately in addition to primary procedure)Q4291Lamellas xt, per square centimeter (add-on, list separately in addition to primary procedure)Q4292Lamellas, per square centimeter (add-on, list separately in addition to primary procedure)Q4293Acesso dl, per square centimeter (add-on, list separately in addition to primary procedure)Q4294Amnio quad-core, per square centimeter (add-on, list separately in addition to primary procedure)Q4295Amnio tri-core amniotic, per square centimeter (add-on, list separately in addition to primary procedure)Q4296Rebound matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4297Emerge matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4298Amniocore pro, per square centimeter (add-on, list separately in addition to primary procedure)Q4299Amniocore pro+, per square centimeter (add-on, list separately in addition to primary procedure)Q4300Acesso tl, per square centimeter (add-on, list separately in addition to primary procedure)Q4301Activate matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4302Complete aca, per square centimeter (add-on, list separately in addition to primary procedure)Q4303Complete aa, per square centimeter (add-on, list separately in addition to primary procedure)Q4304Grafix plus, per square centimeter (add-on, list separately in addition to primary procedure)Q4305American amnion ac tri-layer, per square centimeter (add-on, list separately in addition to primary procedure)Q4306American amnion ac, per square centimeter (add-on, list separately in addition to primary procedure)Q4307American amnion, per square centimeter (add-on, list separately in addition to primary procedure)Q4308Sanopellis, per square centimeter (add-on, list separately in addition to primary procedure)Q4309Via matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4310Procenta, per 100 mgQ4311Acesso, per square centimeter (add-on, list separately in addition to primary procedure)Q4312Acesso ac, per square centimeter (add-on, list separately in addition to primary procedure)Q4313Dermabind fm, per square centimeter (add-on, list separately in addition to primary procedure)Q4314Reeva ft, per square cenitmeter (add-on, list separately in addition to primary procedure)Q4315Regenelink amniotic membrane allograft, per square centimeter (add-on, list separately in addition to primary procedure)Q4316Amchoplast, per square centimeter (add-on, list separately in addition to primary procedure)Q4317Vitograft, per square centimeter (add-on, list separately in addition to primary procedure)Q4318E-graft, per square centimeter (add-on, list separately in addition to primary procedure)Q4319Sanograft, per square centimeter (add-on, list separately in addition to primary procedure)Q4320Pellograft, per square centimeter (add-on, list separately in addition to primary procedure)Q4321Renograft, per square centimeter (add-on, list separately in addition to primary procedure)Q4322Caregraft, per square centimeter (add-on, list separately in addition to primary procedure)Q4323Alloply, per square centimeter (add-on, list separately in addition to primary procedure)Q4324Amniotx, per square centimeter (add-on, list separately in addition to primary procedure)Q4325Acapatch, per square centimeter (add-on, list separately in addition to primary procedure)Q4326Woundplus, per square centimeter (add-on, list separately in addition to primary procedure)Q4327Duoamnion, per square centimeter (add-on, list separately in addition to primary procedure)Q4328Most, per square centimeter (add-on, list separately in addition to primary procedure)Q4329Singlay, per square centimeter (add-on, list separately in addition to primary procedure)Q4330Total, per square centimeter (add-on, list separately in addition to primary procedure)Q4331Axolotl graft, per square centimeter (add-on, list separately in addition to primary procedure)Q4332Axolotl dualgraft, per square centimeter (add-on, list separately in addition to primary procedure)Q4333Ardeograft, per square centimeter (add-on, list separately in addition to primary procedure)Q4334Amnioplast 1, per square centimeter (add-on, list separately in addition to primary procedure)Q4335Amnioplast 2, per square centimeter (add-on, list separately in addition to primary procedure)Q4336Artacent c, per square centimeter (add-on, list separately in addition to primary procedure)Q4337Artacent trident, per square centimeter (add-on, list separately in addition to primary procedure)Q4338Artacent velos, per square centimeter (add-on, list separately in addition to primary procedure)Q4339Artacent vericlen, per square centimeter (add-on, list separately in addition to primary procedure)Q4340Simpligraft, per square centimeter (add-on, list separately in addition to primary procedure)Q4341Simplimax, per square centimeter (add-on, list separately in addition to primary procedure)Q4342Theramend, per square centimeter (add-on, list separately in addition to primary procedure)Q4343Dermacyte ac matrix amniotic membrane allograft, per square centimeter (add-on, list separately in addition to primary procedure)Q4344Tri-membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)Q4345Matrix hd allograft dermis, per square centimeter (add-on, list separately in addition to primary procedure)Q4346Shelter dm matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4347Rampart dl matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4348Sentry sl matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4349Mantle dl matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4350Palisade dm matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4351Enclose tl matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4352Overlay sl matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4353Xceed tl matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4354Palingen dual-layer membrane and dual-layer palingen x-membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4355Abiomend xplus membrane and abiomend xplus hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4356Abiomend membrane and abiomend hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4357Xwrap plus, per square centimeter (add-on, list separately in addition to primary procedure)Q4358Xwrap dual, per square centimeter (add-on, list separately in addition to primary procedure)Q4359Choriply, per square centimeter (add-on, list separately in addition to primary procedure)Q4360Amchoplast fd, per square centimeter (add-on, list separately in addition to primary procedure)Q4361Epixpress, per square centimeter (add-on, list separately in addition to primary procedure)Q4362Cygnus disk, per square centimeter (add-on, list separately in addition to primary procedure)Q4363Amnio burgeon membrane and hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4364Amnio burgeon xplus membrane and xplus hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4365Amnio burgeon dual-layer membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4366Dual layer amnio burgeon x-membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4367Amniocore sl, per square centimeter (add-on, list separately in addition to primary procedure)Q4368Amchothick, per square centimeter (add-on, list separately in addition to primary procedure)Q4369Amnioplast 3, per square centimeter (add-on, list separately in addition to primary procedure)Q4370Aeroguard, per square centimeter (add-on, list separately in addition to primary procedure)Q4371Neoguard, per square centimeter (add-on, list separately in addition to primary procedure)Q4372Amchoplast excel, per square centimeter (add-on, list separately in addition to primary procedure)Q4373Membrane wrap lite, per square centimeter (add-on, list separately in addition to primary procedure)Q4375Duograft ac, per square centimeter (add-on, list separately in addition to primary procedure)Q4376Duograft aa, per square centimeter (add-on, list separately in addition to primary procedure)Q4377Trigraft ft, per square centimeter (add-on, list separately in addition to primary procedure)Q4378Renew ft matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4379Amniodefend ft matrix, per square centimeter (add-on, list separately in addition to primary procedure)Q4380Advograft one, per square centimeter (add-on, list separately in addition to primary procedure)Q4382Advograft dual, per square centimeter (add-on, list separately in addition to primary procedure)Q4383Axolotl graft ultra, per square centimeter (add-on, list separately in addition to primary procedure)Q4384Axolotl dualgraft ultra, per square centimeter (add-on, list separately in addition to primary procedure)Q4385Apollo ft, per square centimeter (add-on, list separately in addition to primary procedure)Q4386Acesso trifaca, per square centimeter (add-on, list separately in addition to primary procedure)Q4387Neothelium ft, per square centimeter (add-on, list separately in addition to primary procedure)Q4388Neothelium 4l, per square centimeter (add-on, list separately in addition to primary procedure)Q4389Neothelium 4l+, per square centimeter (add-on, list separately in addition to primary procedure)Q4390Ascendion, per square centimeter (add-on, list separately in addition to primary procedure)Q4391Amnioplast double, per square centimeter (add-on, list separately in addition to primary procedure)Q4392Grafix duo, per square centimeter (add-on, list separately in addition to primary procedure)Q4393Surgraft ac, per square centimeter (add-on, list separately in addition to primary procedure)Q4394Surgraft aca, per square centimeter (add-on, list separately in addition to primary procedure)Q4395Acelagraft, per square centimeter (add-on, list separately in addition to primary procedure)Q4396Natalin, per square centimeter (add-on, list separately in addition to primary procedure)Q4397Summit aaa, per square centimeter (add-on, list separately in addition to primary procedure)Q4398Summit ac, per square centimeter (add-on, list separately in addition to primary procedure)Q4399Summit fx, per square centimeter (add-on, list separately in addition to primary procedure)Q4400Polygon3 membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4401Absolv3 membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4402Xwrap 2.0, per square centimeter (add-on, list separately in addition to primary procedure)Q4403Xwrap dual plus, per square centimeter (add-on, list separately in addition to primary procedure)Q4404Xwrap hydro plus, per square centimeter (add-on, list separately in addition to primary procedure)Q4405Xwrap fenestra plus, per square centimeter (add-on, list separately in addition to primary procedure)Q4406Xwrap fenestra, per square centimeter (add-on, list separately in addition to primary procedure)Q4407Xwrap tribus, per square centimeter (add-on, list separately in addition to primary procedure)Q4408Xwrap hydro, per square centimeter (add-on, list separately in addition to primary procedure)Q4409Amniomatrixf3x, per square centimeter (add-on, list separately in addition to primary procedure)Q4410Amchomatrixdl, per square centimeter (add-on, list separately in addition to primary procedure)Q4411Amniomatrixf4x, per square centimeter (add-on, list separately in addition to primary procedure)Q4412Choriofix, per square centimeter (add-on, list separately in addition to primary procedure)Q4413Cygnus solo, per square centimeter (add-on, list separately in addition to primary procedure)Q4414Simplichor, per square centimeter (add-on, list separately in addition to primary procedure)Q4415Alexiguard sl-t, per square centimeter (add-on, list separately in addition to primary procedure)Q4416Alexiguard tl-t, per square centimeter (add-on, list separately in addition to primary procedure)Q4417Alexiguard dl-t, per square centimeter (add-on, list separately in addition to primary procedure)Q4418Biolab membrane wrap flow, per square centimeter (add-on, list separately in addition to primary procedure)Q4419Biolab membrane wrap lite flow, per square centimeter (add-on, list separately in addition to primary procedure)Q4420Nuform, per square centimeter (add-on, list separately in addition to primary procedure)Q4421Biolab membrane wrap solo, per square centimeter (add-on, list separately in addition to primary procedure)Q4422A/c wrap, per square centimeter (add-on, list separately in addition to primary procedure)Q4423Biolab tri-membrane wrap flow, per square centimeter (add-on, list separately in addition to primary procedure)Q4424Revive ft, per square centimeter (add-on, list separately in addition to primary procedure)Q4425Revive tl, per square centimeter (add-on, list separately in addition to primary procedure)Q4426Dermabind tl + or dermabind tl x, per square centimeter (add-on, list separately in addition to primary procedure)Q4427Dermabind dl n or dermabind dl + or dermabind dl x, per square centimeter (add-on, list separately in addition to primary procedure)Q4428Dermabind sl n or dermabind sl + or dermabind sl x, per square centimeter (add-on, list separately in addition to primary procedure)Q4429Dermabind ch n or dermabind ch x, per square centimeter (add-on, list separately in addition to primary procedure)Q4431Pma skin substitute product, not otherwise specified (list in addition to primary procedure)Q4432510(k) skin substitute product, not otherwise specified (list in addition to primary procedure)Q4433361 hct/p skin substitute product, not otherwise specified (list in addition to primary procedure)Q4435Renati membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4436Renati ac membrane, per square centimeter (add-on, list separately in addition to primary procedure)Q4437Revival ac, per square centimeter (add-on, list separately in addition to primary procedure)Q4438Pretect, per square centimeter (add-on, list separately in addition to primary procedure)Q4439Instagraft, per square centimeter (add-on, list separately in addition to primary procedure)Q4440Curamatrix, per square centimeter (add-on, list separately in addition to primary procedure)
Procedure codeCODABLE
Q4410
Amchomatrixdl, per square centimeter (add-on, list separately in addition to primary procedure)
Part
HCPCS Level II
Q
Temporary Codes
Q4
Q4001–Q4440
Source

CMS — ICD-10-PCS FY2026, HCPCS Level II october 2026, Procedure Codes 2026.