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    HCPCS Details

    HCPC Q4117
    Short Description Hyalomatrix
    Long Description Hyalomatrix, 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 2011-01-01
    Date Added 2011-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    MSS4011 Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES INC 1 SQ CM 6.25 10 6.25 62.5
    MSS4011H Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES INC 1 SQ CM 6.25 1 6.25 6.25
    MSS4011NS Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES INC 1 SQ CM 6.25 10 6.25 62.5
    MSS4011NSH Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES, INC. 1 SQ CM 6.25 1 6.25 6.25
    MSS4022 Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES INC 1 SQ CM 25 1 25 25
    MSS4022H Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES INC 1 SQ CM 1 1 25 25
    MSS4022NS Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES, INC. 1 SQ CM 25 1 25 250
    MSS4022NSH Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES INC 1 SQ CM 25 1 25 25
    MSS4044 Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES INC 1 SQ CM 1 1 100 100
    MSS4044NS Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES, INC. 1 SQ CM 100 1 100 100
    MSS4048 Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES INC 1 SQ CM 1 1 200 200
    MSS4048NS Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES, INC. 1 SQ CM 200 1 200 200
    MSS4088 Q4117 Hyalomatrix HYALOMATRIX WOUND MATRIX 18 SQ. CM. X 20 SQ. CM. SHEET, 360 SQ. CM EACH MEDLINE INDUSTRIES INC 1 SQ CM 360 1 360 360
    MSS4088NS Q4117 Hyalomatrix Hyalomatrix Wound Matrix MEDLINE INDUSTRIES, INC. 1 SQ CM 360 1 360 360
    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