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Last Modified: 10/16/2024 Location: FL, PR, USVI Business: Part A, Part B

Skin substitute HCPCS codes no longer requiring a paper invoice (JN)

To reduce provider burden, certain contractor priced HCPCS codes no longer require a paper invoice.
When the invoice information is entered in the narrative field on a claim for any of the HCPCS codes listed below, it is not necessary to provide the actual paper invoice for these services. For details, view our article on the process for supplying invoice amount on certain HCPCS codes to avoid rejected claims.

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
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