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    HCPCS Details

    HCPC Q4133
    Short Description Grafix stravix prime pl sqcm
    Long Description Grafix prime, grafixpl prime, stravix and stravixpl, 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 2019-01-01
    Date Added 2013-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    PS11015 Q4133 Grafix stravix prime pl sqcm Grafix prime OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 1 1 3 3
    PS11023 Q4133 Grafix stravix prime pl sqcm Grafix prime OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 1 1 6 6
    PS11034 Q4133 Grafix stravix prime pl sqcm Grafix prime OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 1 1 12 12
    PS11055 Q4133 Grafix stravix prime pl sqcm Grafix prime OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 1 1 25 25
    PS13015 Q4133 Grafix stravix prime pl sqcm GrafixPL Prime OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 3 1 3 3
    PS13016 Q4133 Grafix stravix prime pl sqcm GrafixPL Prime OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 2.01 1 2.01 2.01
    PS13023 Q4133 Grafix stravix prime pl sqcm GrafixPL Prime OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 6 1 6 6
    PS13033 Q4133 Grafix stravix prime pl sqcm GrafixPL Prime OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 9 1 9 9
    PS13034 Q4133 Grafix stravix prime pl sqcm GrafixPL Prime OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 12 1 12 12
    PS13055 Q4133 Grafix stravix prime pl sqcm GrafixPL Prime OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 25 1 25 25
    PS60005 Q4133 Grafix stravix prime pl sqcm Stravix OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 8 1 8 8
    PS60006 Q4133 Grafix stravix prime pl sqcm Stravix OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 4 1 4 4
    PS60008 Q4133 Grafix stravix prime pl sqcm Stravix OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 18 1 18 18
    PS60013 Q4133 Grafix stravix prime pl sqcm Grafix prime OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 2 1 2 1
    PS60036 Q4133 Grafix stravix prime pl sqcm CRYOPRESERVED UMBILICAL TISSUE OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 18 1 18 18
    PS61024 Q4133 Grafix stravix prime pl sqcm STRAVIX PL OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 8 1 8 8
    PS61036 Q4133 Grafix stravix prime pl sqcm STRAVIX PL OSIRIS THERAPEUTICS (SMITH & NEPHEW, INC.) 1 SQ CM 18 1 18 18
    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