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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 ambient or axolotl cryo, 0.1 mg ( Q4215 )

• 105 Artacent cord, per square centimeter ( Q4216 )

• 106 Progenamatrix, per square centimeter ( Q4222 )

• 107 Allogen, per cc ( Q4212 )

• 108 Ascent, 0.5 mg ( Q4213 )

• 109 Cellesta cord, per square centimeter ( Q4214 )

• 110 MyOwn skin, includes harvesting and preparation procedures, per square centimeter ( Q4226 )

• 111 Woundfix, BioWound, Woundfix Plus, BioWound Plus, Woundfix Xplus or BioWound Xplus, per square centimeter ( Q4217 )

• 112 Surgicord, per square centimeter ( Q4218 )

• 113 Surgigraft-dual, per square centimeter ( Q4219 )

• 114 Amniowrap2, per square centimeter ( Q4221 )

• 115 Amniocore, per square centimeter ( Q4227 )

• 116 Cogenex amniotic membrane, per square centimeter ( Q4229 )

• 117 Cogenex flowable amnion, per 0.5 cc ( Q4230 )

• 118 Corplex p, per cc ( Q4231 )

• 119 Corplex, per square centimeter ( Q4232 )

• 120 Surfactor or nudyn, per 0.5 cc ( Q4233 )

• 121 Xcellerate, per square centimeter ( Q4234 )

• 122 Amniorepair or altiply, per square centimeter ( Q4235 )

• 123 Carepatch, per square centimeter ( Q4236 )

• 124 Cryo-cord, per square centimeter ( Q4237 )

• 125 Derm-maxx, per square centimeter ( Q4238 )

• 126 Amnio-maxx or amnio-maxx lite, per square centimeter ( Q4239 )

• 127 Corecyte, for topical use only, per 0.5 cc ( Q4240 )

• 128 Polycyte, for topical use only, per 0.5 cc ( Q4241 )

• 129 Amniocyte plus, per 0.5 cc ( Q4242 )

• 130 Amniotext, per cc ( Q4245 )

• 131 Coretext or protext, per cc ( Q4246 )

• 132 Amniotext patch, per square centimeter ( Q4247 )

• 133 Dermacyte amniotic membrane allograft, per square centimeter ( Q4248 )

• 134 Amniply, for topical use only, per square centimeter ( Q4249 )

• 135 Amnioamp-mp, per square centimeter ( Q4250 )

• 136 Novafix dl, per square centimeter ( Q4254 )

• 137 Reguard, for topical use only, per square centimeter ( Q4255 )

• 138 Vim, per square centimeter ( Q4251 )

• 139 Vendaje, per square centimeter ( Q4252 )

• 140 Zenith amniotic membrane, per square centimeter ( Q4253 )

• 141 Cygnus matrix, per square centimeter ( Q4199 )

• 142 Human health factor 10 amniotic patch (hhf10-p), per square centimeter ( Q4224 )

• 143 Amniobind or dermabind tl, per square centimeter ( Q4225 )

• 144 Mlg-complete, per square centimeter ( Q4256 )

• 145 Relese, per square centimeter ( Q4257 )

• 146 Enverse, per square centimeter ( Q4258 )

• 147 Celera dual layer or celera dual membrane, per square centimeter ( Q4259 )

• 148 Signature apatch, per square centimeter ( Q4260 )

• 149 Tag, per square centimeter ( Q4261 )

• 150 Dual layer impax membrane, per square centimeter ( Q4262 )

• 151 Surgraft tl, per square centimeter ( Q4263 )

• 152 Cocoon membrane, per square centimeter ( Q4264 )

• 153 Neostim tl, per square centimeter ( Q4265 )

• 154 Neostim membrane, per square centimeter ( Q4266 )

• 155 Neostim dl, per square centimeter ( Q4267 )

• 156 Surgraft ft, per square centimeter ( Q4268 )

• 157 Surgraft xt, per square centimeter ( Q4269 )

• 158 Complete sl, per square centimeter ( Q4270 )

• 159 Complete ft, per square centimeter ( Q4271 )

• 160 Esano a, per square centimeter ( Q4272 )

• 161 Esano aaa, per square centimeter ( Q4273 )

• 162 Esano ac, per square centimeter ( Q4274 )

• 163 Esano aca, per square centimeter ( Q4275 )

• 164 Orion, per square centimeter ( Q4276 )

• 165 Epieffect, per square centimeter ( Q4278 )

• 166 Xcell amnio matrix, per square centimeter ( Q4280 )

• 167 Barrera sl or barrera dl, per square centimeter ( Q4281 )

• 168 Cygnus dual, per square centimeter ( Q4282 )

• 169 Biovance tri-layer or biovance 3l, per square centimeter ( Q4283 )

• 170 Dermabind sl, per square centimeter ( Q4284 )

• 171 Nudyn dl or nudyn dl mesh, per square centimeter ( Q4285 )

• 172 Nudyn sl or nudyn slw, per square centimeter ( Q4286 )

• 173 Vendaje ac, per square centimeter ( Q4279 )

• 174 Dermabind dl, per square centimeter ( Q4287 )

• 175 Dermabind ch, per square centimeter ( Q4288 )

• 176 Revoshield + amniotic barrier, per square centimeter ( Q4289 )

• 177 Membrane wrap-hydro, per square centimeter ( Q4290 )

• 178 Lamellas xt, per square centimeter ( Q4291 )

• 179 Lamellas, per square centimeter ( Q4292 )

• 180 Acesso dl, per square centimeter ( Q4293 )

• 181 Amnio quad-core, per square centimeter ( Q4294 )

• 182 Amnio tri-core amniotic, per square centimeter ( Q4295 )

• 183 Rebound matrix, per square centimeter ( Q4296 )

• 184 Emerge matrix, per square centimeter ( Q4297 )

• 185 Amniocore pro, per square centimeter ( Q4298 )

• 186 Amniocore pro+, per square centimeter ( Q4299 )

• 187 Acesso tl, per square centimeter ( Q4300 )

• 188 Activate matrix, per square centimeter ( Q4301 )

• 189 Complete aca, per square centimeter ( Q4302 )

• 190 Complete aa, per square centimeter ( Q4303 )

• 191 Grafix plus, per square centimeter ( Q4304 )

• 192 American amnion ac tri-layer, per square centimeter ( Q4305 )

• 193 American amnion ac, per square centimeter ( Q4306 )

• 194 American amnion, per square centimeter ( Q4307 )

• 195 Sanopellis, per square centimeter ( Q4308 )

• 196 Via matrix, per square centimeter ( Q4309 )

• 197 Procenta, per 100 mg ( Q4310 )

• 198 Acesso, per square centimeter ( Q4311 )

• 199 Acesso ac, per square centimeter ( Q4312 )

• 200 Dermabind fm, per square centimeter ( Q4313 )

• 201 Reeva ft, per square cenitmeter ( Q4314 )

• 202 Regenelink amniotic membrane allograft, per square centimeter ( Q4315 )

• 203 Amchoplast, per square centimeter ( Q4316 )

• 204 Vitograft, per square centimeter ( Q4317 )

• 205 E-graft, per square centimeter ( Q4318 )

• 206 Sanograft, per square centimeter ( Q4319 )

• 207 Pellograft, per square centimeter ( Q4320 )

• 208 Renograft, per square centimeter ( Q4321 )

• 209 Caregraft, per square centimeter ( Q4322 )

• 210 Alloply, per square centimeter ( Q4323 )

• 211 Amniotx, per square centimeter ( Q4324 )

• 212 Acapatch, per square centimeter ( Q4325 )

• 213 Woundplus, per square centimeter ( Q4326 )

• 214 Duoamnion, per square centimeter ( Q4327 )

• 215 Most, per square centimeter ( Q4328 )

• 216 Singlay, per square centimeter ( Q4329 )

• 217 Total, per square centimeter ( Q4330 )

• 218 Axolotl graft, per square centimeter ( Q4331 )

• 219 Axolotl dualgraft, per square centimeter ( Q4332 )

• 220 Ardeograft, per square centimeter ( Q4333 )