Search by Drug Name, NDC or Jcode

    Internal Navigation

    HCPCS Details

    HCPC Q4201
    Short Description Matrion 1 sq cm
    Long Description Matrion, 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 2019-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    PAC06 Q4201 Matrion 1 sq cm Matrion LIFENET HEALTH 1 SQ CM 6 1 6 6
    PAC06M Q4201 Matrion 1 sq cm Matrion LIFENET HEALTH 1 SQ CM 6 1 6 6
    PAC12 Q4201 Matrion 1 sq cm Matrion LIFENET HEALTH 1 SQ CM 12 1 12 12
    PAC12M Q4201 Matrion 1 sq cm Matrion LIFENET HEALTH 1 SQ CM 12 1 12 12
    PAC20MM Q4201 Matrion 1 sq cm Matrion LIFENET HEALTH 1 SQ CM 3 1 3 3
    PAC25 Q4201 Matrion 1 sq cm Matrion LIFENET HEALTH 1 SQ CM 25 1 25 25
    PAC25M Q4201 Matrion 1 sq cm Matrion LIFENET HEALTH 1 SQ CM 25 1 25 25
    PAC64 Q4201 Matrion 1 sq cm ALLOGRAFT PLACENTAL MATRIX LIFENET HEALTH 1 SQ CM 64 1 64 64
    PAC64M Q4201 Matrion 1 sq cm Matrion LIFENET HEALTH 1 SQ CM 64 1 64 64
    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