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    HCPCS Details

    HCPC Q4110
    Short Description Primatrix
    Long Description Primatrix, per square centimeter
    Pricing indicator 51
    Coverage code C
    ASC payment group code
    BETOS2 code O1E
    Action code N
    Type of service 1
    Effective date 2014-01-01
    Date Added 2009-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    08533607009 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 6 3 6 18
    08533607112 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 120 1 120 120
    08533607125 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 250 1 250 250
    08533607225 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 500 1 500 500
    08533607440 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 16 1 16 16
    08533607660 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 36 1 36 36
    08533607812 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 96 1 96 96
    08533607880 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 64 1 64 64
    08533674440 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 16 1 16 16
    08533674660 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 36 1 36 36
    08533674880 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 64 1 64 64
    08533675014 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 2 1 2 2
    08533675018 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 3 1 3 3
    08533675125 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 250 1 250 250
    08533675220 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 4 1 4 4
    08533675225 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 500 1 500 500
    08533675330 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 9 1 9 9
    08533675440 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 16 1 16 16
    08533675550 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 25 1 25 25
    08533675660 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 36 1 36 36
    08533675812 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 96 1 96 96
    08533675880 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 64 1 64 64
    08533711112 Q4110 Primatrix PriMatrix Ag TEI BIOSCIENCES INC. 1 SQ CM 120 1 120 120
    08533711125 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 250 1 250 250
    08533711225 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 500 1 500 500
    08533711440 Q4110 Primatrix PriMatrix Ag TEI BIOSCIENCES INC. 1 SQ CM 16 1 16 16
    08533711660 Q4110 Primatrix PriMatrix Ag TEI BIOSCIENCES INC. 1 SQ CM 36 1 36 36
    08533711812 Q4110 Primatrix PriMatrix Ag TEI BIOSCIENCES INC. 1 SQ CM 96 1 96 96
    08533711880 Q4110 Primatrix PriMatrix Ag TEI BIOSCIENCES INC. 1 SQ CM 64 1 64 64
    08533714125 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 250 1 250 250
    08533714225 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 500 1 500 500
    08533714440 Q4110 Primatrix PriMatrix Ag TEI BIOSCIENCES INC. 1 SQ CM 16 1 16 16
    08533714660 Q4110 Primatrix PriMatrix Ag TEI BIOSCIENCES INC. 1 SQ CM 36 1 36 36
    08533714812 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 96 1 96 96
    08533714880 Q4110 Primatrix PriMatrix Ag TEI BIOSCIENCES INC. 1 SQ CM 64 1 64 64
    08533715112 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 120 1 120 120
    08533715125 Q4110 Primatrix PriMatrix Ag TEI BIOSCIENCES INC. 1 SQ CM 250 1 250 250
    08533715440 Q4110 Primatrix PriMatrix Ag TEI BIOSCIENCES INC. 1 SQ CM 16 1 16 16
    08533715660 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 36 1 36 36
    08533715812 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 96 1 96 96
    08533715880 Q4110 Primatrix PriMatrix TEI BIOSCIENCES INC. 1 SQ CM 64 1 64 64
    The ASP crosswalks are maintained by the Division of Data Analysis and Market Based Pricing to support ASP-based Medicare Part B payments only. The crosswalks are intended to help the public (including entities that submit manufacturer ASP data and providers who bill for drugs) understand which drug products (identified by NDCs) are assigned to which HCPCS billing codes. The crosswalks are not intended to be a comprehensive list of all drugs/NDCs available in the United States. The NDC to HCPCS Crosswalk also includes information on the NDC package size and the number of billable units (as defined by the HCPCS code descriptor). Comments on the file may be sent to [email protected].

    HCPCS Billing Calculator

    Dosage given to patient (per dose)
    HCPCS Dosage 1 SQ CM
    HCPCS/CPT Billing Units 1
    Total doses ordered
    Billing Units 1