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    HCPCS Details

    HCPC Q4118
    Short Description Matristem micromatrix
    Long Description Matristem micromatrix, 1 mg
    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 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
    86190000112 Q4118 Matristem micromatrix ACELL MICROMATRIX 20MG ACELL, INC 1 MG 20 1 20 20
    86190000113 Q4118 Matristem micromatrix ACELL MICROMATRIX 30MG ACELL, INC 1 MG 30 1 30 30
    86190000114 Q4118 Matristem micromatrix ACELL MICROMATRIX 60MG ACELL, INC 1 MG 60 1 60 60
    86190000115 Q4118 Matristem micromatrix ACELL MICROMATRIX 100MG ACELL, INC 1 MG 100 1 100 100
    86190000116 Q4118 Matristem micromatrix ACELL MICROMATRIX (FINE) 100MG ACELL, INC 1 MG 100 1 100 100
    86190000117 Q4118 Matristem micromatrix ACELL MICROMATRIX 200MG ACELL, INC 1 MG 200 1 200 200
    86190000118 Q4118 Matristem micromatrix ACELL MICROMATRIX 500MG ACELL, INC 1 MG 500 1 500 500
    86190000120 Q4118 Matristem micromatrix ACELL MICROMATRIX 1000MG ACELL, INC 1 MG 1000 1 1000 1000
    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 MG
    HCPCS/CPT Billing Units 1
    Total doses ordered
    Billing Units 1