Code |
Description |
Effective "from" date of service |
Effective "through" date of service |
---|---|---|---|
A2006 |
NovoSorb SynPath dermal matrix, per sq cm |
1/1/2024 |
Present |
A2009 |
Symphony, per sq cm |
1/1/2024 |
Present |
A2010 |
Apis, per sq cm |
1/1/2024 |
Present |
A2011 |
Supra SDRM, per sq cm |
1/1/2024 |
Present |
A2012 |
SUPRATHEL, per sq cm |
1/1/2024 |
Present |
A2016 |
PermeaDerm B, per sq cm |
1/1/2024 |
Present |
A2017 |
PermeaDerm Glove, each |
1/1/2024 |
Present |
A2018 |
PermeaDerm C, per sq cm |
1/1/2024 |
Present |
A2020 |
Ac5 Advanced Wound system |
1/1/2024 |
Present |
A2026 |
Restrata minimatrix, 5 mg |
4/1/2024 |
Present |
A4100 |
Skin substitute, FDA cleared as a device, not otherwise specified |
1/1/2024 |
Present |
A2027 |
Matriderm, per square centimeter |
10/1/2024 |
Present |
A2029 |
Mirotract wound matrix sheet, per cubic centimeter |
10/1/2024 |
Present |
Q4107 |
GRAFTJACKET, per sq cm |
1/1/2024 |
Present |
Q4112 |
Cymetra, injectable, 1 cc |
1/1/2024 |
Present |
Q4113 |
GRAFTJACKET XPRESS, injectable, 1 cc |
1/1/2024 |
Present |
Q4116 |
AlloDerm, per sq cm |
1/1/2024 |
Present |
Q4125 |
ArthroFlex, per sq cm |
1/1/2024 |
Present |
Q4130 |
Strattice TM, per sq cm |
1/1/2024 |
Present |
Q4134 |
HMatrix, per sq cm |
1/1/2024 |
Present |
Q4135 |
Mediskin, per sq cm |
1/1/2024 |
Present |
Q4136 |
E-Z Derm, per sq cm |
1/1/2024 |
Present |
Q4138 |
BioDFence DryFlex, per sq cm |
1/1/2024 |
Present |
Q4139 |
AmnioMatrix or BioDMatrix, injectable, 1 cc |
1/1/2024 |
Present |
Q4140 |
BioDFence, per sq cm |
1/1/2024 |
Present |
Q4142 |
XCM biologic tissue matrix, per sq cm |
1/1/2024 |
Present |
Q4145 |
EpiFix, injectable, 1 mg |
1/1/2024 |
Present |
Q4146 |
Tensix, per sq cm |
1/1/2024 |
Present |
Q4147 |
Architect, Architect PX, or Architect FX, extracellular matrix, per sq cm |
1/1/2024 |
Present |
Q4157 |
Revitalon, per sq cm |
1/1/2024 |
Present |
Q4162 |
WoundEx Flow, BioSkin Flow, 0.5 cc |
1/1/2024 |
Present |
Q4168 |
AmnioBand, 1 mg |
1/1/2024 |
Present |
Q4174 |
PalinGen or ProMatrX, 0.36 mg per 0.25 cc |
1/1/2024 |
Present |
Q4176 |
Neopatch or therion, per square centimeter |
1/1/2024 |
Present |
Q4179 |
FlowerDerm, per sq cm |
1/1/2024 |
Present |
Q4183 |
Surgigraft, per sq cm |
1/1/2024 |
Present |
Q4184 |
Cellesta or Cellesta Duo, per sq cm |
1/1/2023 |
1/31/2024 |
Q4185 |
Cellesta Flowable Amnion (25 mg per cc); per 0.5 cc |
1/1/2024 |
Present |
Q4189 |
Artacent AC, 1 mg |
1/1/2024 |
Present |
Q4192 |
Restorigin, 1 cc |
1/1/2024 |
Present |
Q4198 |
Genesis Amniotic Membrane, per sq cm |
1/1/2024 |
Present |
Q4200 |
SkinTE, per sq cm |
1/1/2024 |
Present |
Q4202 |
Keroxx (2.5 g/cc), 1 cc |
1/1/2024 |
Present |
Q4204 |
XWRAP, per sq cm |
1/1/2024 |
2/29/2024 |
Q4208 |
Novafix, per sq cm |
1/1/2024 |
Present |
Q4209 |
SurGraft, per sq cm |
1/1/2024 |
Present |
Q4211 |
Amnion Bio or AxoBioMembrane, per sq cm |
1/1/2024 |
Present |
Q4212 |
AlloGen, per cc |
1/1/2024 |
Present |
Q4214 |
Cellesta Cord, per sq cm |
1/1/2024 |
Present |
Q4215 |
Axolotl Ambient or Axolotl Cryo, 0.1 mg |
1/1/2024 |
Present |
Q4216 |
Artacent Cord, per sq cm |
1/1/2024 |
Present |
Q4218 |
SurgiCORD, per sq cm |
1/1/2024 |
Present |
Q4219 |
SurgiGRAFT-DUAL, per sq cm |
1/1/2024 |
Present |
Q4220 |
BellaCell HD or Surederm, per sq cm |
1/1/2024 |
Present |
Q4224 |
Human Health Factor 10 Amniotic Patch (HHF10-P), per sq cm |
1/1/2024 |
Present |
Q4230 |
Cogenex Flowable Amnion, per 0.5 cc |
1/1/2024 |
9/30/2024 |
Q4233 |
SurFactor or NuDyn, per 0.5 cc |
1/1/2024 |
Present |
Q4237 |
Cryo-Cord, per sq cm |
1/1/2024 |
Present |
Q4240 |
CoreCyte, for topical use only, per 0.5 cc |
1/1/2024 |
Present |
Q4241 |
PolyCyte, for topical use only, per 0.5 cc |
1/1/2024 |
Present |
Q4242 |
AmnioCyte Plus, per 0.5 cc |
1/1/2024 |
Present |
Q4245 |
AmnioText, per cc |
1/1/2024 |
Present |
Q4254 |
Novafix DL, per sq cm |
1/1/2024 |
Present |
Q4255 |
REGUaRD, for topical use only, per sq cm |
1/1/2024 |
Present |
Q4260 |
Signature APatch, per sq cm |
1/1/2024 |
Present |
Q4264 |
Cocoon membrane, per square centimeter |
1/1/2024 |
8/31/2024 |
Q4269 |
Surgraft xt, per sq cm |
1/1/2024 |
Present |
Q4270 |
Complete sl, per sq cm |
1/1/2024 |
Present |
Q4273 |
Esano aaa, per sq cm |
1/1/2024 |
Present |
Q4279 |
Vendaje ac, per square centimeter |
1/1/2024 |
Present |
Q4280 |
Xcell amnio matrix, per square centimeter |
1/1/2024 |
Present |
Q4284 |
Dermabind sl, per sq cm |
1/1/2024 |
Present |
Q4285 |
Nudyn dl or nudyn dl mesh, per sq cm |
1/1/2024 |
Present |
Q4286 |
Nudyn sl or nudyn slw, per sq cm |
1/1/2024 |
Present |
Q4287 |
Dermabind dl, per square centimeter |
1/1/2024 |
Present |
Q4288 |
Dermabind ch, per square centimeter |
1/1/2024 |
Present |
Q4289 |
Revoshield + amniotic barrier, per square centimeter |
1/1/2024 |
Present |
Q4291 |
Lamellas xt, per square centimeter |
1/1/2024 |
Present |
Q4292 |
Lamellas, per square centimeter |
1/1/2024 |
Present |
Q4293 |
Acesso dl, per square centimeter |
1/1/2024 |
9/30/2024 |
Q4296 |
Rebound matrix, per square centimeter |
1/1/2024 |
9/30/2024 |
Q4298 |
Amnicore pro, per square centimeter |
1/1/2024 |
Present |
Q4299 |
Amnicore pro+, per square centimeter |
1/1/2024 |
Present |
Q4300 |
Acesso tl, per square centimeter |
1/1/2024 |
Present |
Q4302 |
Complete aca, per square centimeter |
1/1/2024 |
Present |
Q4303 |
Complete aa, per square centimeter |
1/1/2024 |
3/24/2024 |
Q4305 |
American amnion ac tri-layer, per square centimeter |
4/1/2024 |
Present |
Q4306 |
American amnion ac, per square centimeter |
4/1/2024 |
Present |
Q4307 |
American amnion, per square centimeter |
4/1/2024 |
Present |
Q4308 |
Sanopellis, per square centimeter |
4/1/2024 |
Present |
Q4311 |
Acesso, per square centimeter |
7/1/2024 |
Present |
Q4312 |
Acesso ac, per square centimeter |
7/1/2024 |
Present |
Q4314 |
Reeva ft, per square centimeter |
7/1/2024 |
Present |
Q4315 |
Regenelink amniotic membrane allograft, per square centimeter |
7/1/2024 |
Present |
Q4316 |
Amchoplast, per square centimeter |
7/1/2024 |
Present |
Q4317 |
Vitograft, per square centimeter |
7/1/2024 |
Present |
Q4318 |
E-graft, per square centimeter |
7/1/2024 |
Present |
Q4321 |
Renograft, per square centimeter |
7/1/2024 |
Present |
Q4322 |
Caregraft, per square centimeter |
7/1/2024 |
Present |
Q4323 |
Alloply, per square centimeter |
7/1/2024 |
Present |
Q4324 |
Amniotx, per square centimeter |
7/1/2024 |
Present |
Q4325 |
Acapatch, per square centimeter |
7/1/2024 |
Present |
Q4327 |
Duoamnion, per square centimeter |
7/1/2024 |
Present |
Q4328 |
Most, per square centimeter |
7/1/2024 |
Present |
Q4329 |
Singlay, per square centimeter |
7/1/2024 |
Present |
Q4330 |
Total, per square centimeter |
7/1/2024 |
Present |
Q4334 |
Amnioplast 1, per square centimeter |
10/1/2024 |
Present |
Q4335 |
Amnioplast 2, per square centimeter |
10/1/2024 |
Present |
Q4336 |
Artacent c, per square centimeter |
10/1/2024 |
Present |
Q4337 |
Artacent trident, per square centimeter |
10/1/2024 |
Present |
Q4338 |
Artacent velos, per square centimeter |
10/1/2024 |
Present |
Q4339 |
Artacent vericlen, per square centimeter |
10/1/2024 |
Present |
Q4340 |
Simpligraft, per square centimeter |
10/1/2024 |
Present |
Q4341 |
Simplimax, per square centimeter |
10/1/2024 |
Present |
Q4342 |
Theramend, per square centimeter |
10/1/2024 |
Present |
Q4344 |
Tri-membrane wrap, per square centimeter |
10/1/2024 |
Present |
Q4345 |
Matrix hd allograft dermis, per square centimeter |
10/1/2024 |
Present |