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    HCPCS Details

    HCPC Q4126
    Short Description Memoderm/derma/tranz/integup
    Long Description Memoderm, dermaspan, tranzgraft or integuply, 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 2013-01-01
    Date Added 2012-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    88030404040 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 16 1 16 16
    88030404040 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 32 1 32 32
    88030404101 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 120 1 120 120
    88030404121 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 144 1 144 144
    88030405020 Q4126 Memoderm/derma/tranz/integup DERMASPAN ACD (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 4 1 4 4
    88030405020 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 6 1 6 6
    88030405020 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 8 1 8 8
    88030405030 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 9 1 9 9
    88030407040 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 16 1 16 16
    88030407040 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 32 1 32 32
    88030409030 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 21 1 21 21
    88030409040 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 28 1 28 28
    88030409041 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 48 1 48 48
    88030409041 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 64 1 64 64
    88030409051 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 50 1 50 50
    88030409061 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 72 1 72 72
    88030409061 Q4126 Memoderm/derma/tranz/integup DERMASPAN ZIMMER BIOMET BIOLOGICS 1 SQ CM 96 1 96 96
    88030409081 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 96 1 96 96
    88030409081 Q4126 Memoderm/derma/tranz/integup DERMASPAN ZIMMER BIOMET BIOLOGICS 1 SQ CM 104 1 104 104
    88030409081 Q4126 Memoderm/derma/tranz/integup DERMASPAN ZIMMER BIOMET BIOLOGICS 1 SQ CM 128 1 128 128
    88030409111 Q4126 Memoderm/derma/tranz/integup DERMASPAN ZIMMER BIOMET BIOLOGICS 1 SQ CM 154 1 154 154
    88030409121 Q4126 Memoderm/derma/tranz/integup DERMASPAN ZIMMER BIOMET BIOLOGICS 1 SQ CM 144 1 144 144
    88030409121 Q4126 Memoderm/derma/tranz/integup DERMASPAN ZIMMER BIOMET BIOLOGICS 1 SQ CM 228 1 228 228
    88030409162 Q4126 Memoderm/derma/tranz/integup DERMASPAN ZIMMER BIOMET BIOLOGICS 1 SQ CM 320 1 320 320
    88030411040 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 28 1 28 28
    88030411050 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 25 1 25 25
    88030411051 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 50 1 50 50
    88030420030 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 21 1 21 21
    88030420040 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 28 1 28 28
    88030420041 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 48 1 48 48
    88030420041 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 64 1 64 64
    88030420051 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 50 1 50 50
    88030420061 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 72 1 72 72
    88030420061 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 96 1 96 96
    88030420081 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 96 1 96 96
    88030420081 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 128 1 128 128
    88030420121 Q4126 Memoderm/derma/tranz/integup DERMASPAN ZIMMER BIOMET BIOLOGICS 1 SQ CM 144 1 144 144
    88030420162 Q4126 Memoderm/derma/tranz/integup DERMASPAN (ZIMMER BIOMET) BIOLOGICS 1 SQ CM 320 1 320 320
    88030428030 Q4126 Memoderm/derma/tranz/integup DERMASPAN ZIMMER BIOMET BIOLOGICS 1 SQ CM 21 1 21 21
    88030428040 Q4126 Memoderm/derma/tranz/integup DERMASPAN ZIMMER BIOMET BIOLOGICS 1 SQ CM 28 1 28 28
    88030428040 Q4126 Memoderm/derma/tranz/integup DERMASPAN ZIMMER BIOMET BIOLOGICS 1 SQ CM 32 1 32 32
    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