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    HCPCS Details

    HCPC Q4137
    Short Description Amnioexcel biodexcel 1sq cm
    Long Description Amnioexcel, amnioexcel plus or biodexcel, 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 2014-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    00995802110 Q4137 Amnioexcel biodexcel 1sq cm AMNIOEXCEL BIODLOGICS LLC 1 SQ CM 3 1 3 3
    00995802120 Q4137 Amnioexcel biodexcel 1sq cm AMNIOEXCEL BIODLOGICS LLC 1 SQ CM 6 1 6 6
    00995802130 Q4137 Amnioexcel biodexcel 1sq cm AmnioExcel BIODLOGICS LLC 1 SQ CM 16 1 16 16
    00995802140 Q4137 Amnioexcel biodexcel 1sq cm AMNIOEXCEL BIODLOGICS LLC 1 SQ CM 32 1 32 32
    00995802200 Q4137 Amnioexcel biodexcel 1sq cm AMNIOEXCEL BIODLOGICS LLC 1 SQ CM 100 1 100 100
    00995802210 Q4137 Amnioexcel biodexcel 1sq cm AMNIOEXCEL BIODLOGICS LLC 1 SQ CM 1 1 1 1
    00995802220 Q4137 Amnioexcel biodexcel 1sq cm AMNIOEXCEL BIODLOGICS LLC 1 SQ CM 2 1 2 2
    00995802230 Q4137 Amnioexcel biodexcel 1sq cm AMNIOEXCEL BIODLOGICS LLC 1 SQ CM 3 1 3 3
    00995802240 Q4137 Amnioexcel biodexcel 1sq cm AMNIOEXCEL BIODLOGICS LLC 1 SQ CM 5 1 5 5
    00995802250 Q4137 Amnioexcel biodexcel 1sq cm AMNIOEXCEL BIODLOGICS LLC 1 SQ CM 13 1 13 13
    00995802260 Q4137 Amnioexcel biodexcel 1sq cm AMNIOEXCEL BIODLOGICS LLC 1 SQ CM 25 1 25 25
    00995802271 Q4137 Amnioexcel biodexcel 1sq cm AmnioExcel Plus BIODLOGICS LLC 1 SQ CM 4 1 4 4
    00995802281 Q4137 Amnioexcel biodexcel 1sq cm AmnioExcel Plus BIODLOGICS LLC 1 SQ CM 12 1 12 12
    00995802291 Q4137 Amnioexcel biodexcel 1sq cm AmnioExcel Plus BIODLOGICS LLC 1 SQ CM 20 1 20 20
    00995802301 Q4137 Amnioexcel biodexcel 1sq cm AmnioExcel Plus BIODLOGICS LLC 1 SQ CM 40 1 40 40
    00995802311 Q4137 Amnioexcel biodexcel 1sq cm AmnioExcel Plus BIODLOGICS LLC 1 SQ CM 3 1 3 3
    00995802321 Q4137 Amnioexcel biodexcel 1sq cm AmnioExcel Plus BIODLOGICS LLC 1 SQ CM 9 1 9 9
    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