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    HCPCS Details

    HCPC Q4180
    Short Description Revita, per sq cm
    Long Description Revita, 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 2018-01-01
    Date Added 2018-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    86047100250 Q4180 Revita, per sq cm REVITA STIMLABS LLC 1 SQ CM 1.78 1 1.78 1.78
    86945700030 Q4180 Revita, per sq cm REVITA STIMLABS LLC 1 SQ CM 4 1 4 4
    86945700031 Q4180 Revita, per sq cm REVITA STIMLABS LLC 1 SQ CM 6 1 6 6
    86945700032 Q4180 Revita, per sq cm REVITA STIMLABS LLC 1 SQ CM 16 1 16 16
    86945700033 Q4180 Revita, per sq cm REVITA STIMLABS LLC 1 SQ CM 24 1 24 24
    86945700034 Q4180 Revita, per sq cm REVITA STIMLABS LLC 1 SQ CM 36 1 36 36
    86945700035 Q4180 Revita, per sq cm REVITA STIMLABS LLC 1 SQ CM 48 1 48 48
    86945700039 Q4180 Revita, per sq cm REVITA STIMLABS LLC 1 SQ CM 24 1 24 24
    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