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    HCPCS Details

    HCPC Q4175
    Short Description Miroderm
    Long Description Miroderm, 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 2017-01-01
    Date Added 2017-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    85707200506 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 21 1 21 21
    85707200507 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 25 1 25 25
    85707200508 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 64 1 64 64
    85707200509 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 70 1 70 70
    85707200510 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 120 1 120 120
    85707200511 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 21 1 21 21
    85707200512 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 25 1 25 25
    85707200513 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 64 1 64 64
    85707200514 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 70 1 70 70
    85707200515 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 120 1 120 120
    85707200516 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 9 1 9 9
    85707200517 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 16 1 16 16
    85707200518 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 9 1 9 9
    85707200519 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 28 1 28 28
    85707200520 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 9 1 9 9
    85707200521 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 16 1 16 16
    85707200522 Q4175 Miroderm MIRODERM Fenestrated Plus REPRISE BIOMEDICAL, INC. 1 SQ CM 21 1 21 21
    85707200523 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 25 1 25 25
    85707200524 Q4175 Miroderm MIRODERM Fenestrated Plus REPRISE BIOMEDICAL, INC. 1 SQ CM 64 1 64 64
    85707200525 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 70 1 70 70
    85707200526 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 120 1 120 120
    85707200529 Q4175 Miroderm MIRODERM Fenestrated REPRISE BIOMEDICAL, INC. 1 SQ CM 6 1 6 6
    85707200530 Q4175 Miroderm MIRODERM REPRISE BIOMEDICAL, INC. 1 SQ CM 4 1 4 4
    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