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    HCPCS Details

    HCPC Q4151
    Short Description Amnioband, guardian 1 sq cm
    Long Description Amnioband or guardian, 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 2015-01-01
    Date Added 2015-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    WC3010 Q4151 Amnioband, guardian 1 sq cm WC AmnioBand MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 0.8 1 0.8 0.8
    WC3014 Q4151 Amnioband, guardian 1 sq cm WC AmnioBand MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 1.5 1 1.5 1.5
    WC3016 Q4151 Amnioband, guardian 1 sq cm AmnioBand Membrane MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 2 1 2 2
    WC3018 Q4151 Amnioband, guardian 1 sq cm WC AmnioBand MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 2.5 1 2.5 2.5
    WC3022 Q4151 Amnioband, guardian 1 sq cm WC AmnioBand MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 1 1 4 4
    WC3023 Q4151 Amnioband, guardian 1 sq cm AmnioBand Membrane MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 6 1 6 6
    WC3024 Q4151 Amnioband, guardian 1 sq cm WC AmnioBand MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 8 1 8 8
    WC3034 Q4151 Amnioband, guardian 1 sq cm WC AmnioBand MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 12 1 12 12
    WC3038 Q4151 Amnioband, guardian 1 sq cm AmnioBand Membrane MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 24 1 24 24
    WC3044 Q4151 Amnioband, guardian 1 sq cm WC AmnioBand MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 1 1 16 16
    WC3046 Q4151 Amnioband, guardian 1 sq cm WC AmnioBand MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 1 1 24 24
    WC3056 Q4151 Amnioband, guardian 1 sq cm AmnioBand Membrane MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 30 1 30 30
    WC3077 Q4151 Amnioband, guardian 1 sq cm AmnioBand Membrane MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 49 1 49 49
    WC9002 Q4151 Amnioband, guardian 1 sq cm AmnioBand Viable MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 4 1 4 4
    wc9005 Q4151 Amnioband, guardian 1 sq cm AmnioBand Viable MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 25 1 25 25
    wc9014 Q4151 Amnioband, guardian 1 sq cm AmnioBand Viable MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 1.54 1 1.54 1.54
    WC9018 Q4151 Amnioband, guardian 1 sq cm AmnioBand Viable MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 2.54 1 2.54 2.54
    WC9024 Q4151 Amnioband, guardian 1 sq cm AmnioBand Viable MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 8 1 8 8
    WC9034 Q4151 Amnioband, guardian 1 sq cm AmnioBand Viable MUSCULOSKELETAL TRANSPLANT FOUNDATION 1 SQ CM 12 1 12 12
    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