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    HCPCS Details

    HCPC Q4205
    Short Description Membrane graft or wrap sq cm
    Long Description Membrane graft or membrane wrap, 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 2019-10-01
    Date Added 2019-10-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    50016091605 Q4205 Membrane graft or wrap sq cm Membrane Wrap BIOLAB SCIENCES INC 1 SQ CM 1 1 1 1
    50016091606 Q4205 Membrane graft or wrap sq cm Membrane Wrap BIOLAB SCIENCES INC 1 SQ CM 4 1 4 4
    50016091607 Q4205 Membrane graft or wrap sq cm Membrane Wrap BIOLAB SCIENCES INC 1 SQ CM 6 1 6 6
    50016091608 Q4205 Membrane graft or wrap sq cm Membrane Wrap BIOLAB SCIENCES INC 1 SQ CM 16 1 16 16
    50016091609 Q4205 Membrane graft or wrap sq cm Membrane Wrap BIOLAB SCIENCES INC 1 SQ CM 24 1 24 24
    50016091610 Q4205 Membrane graft or wrap sq cm Membrane Wrap BIOLAB SCIENCES INC 1 SQ CM 32 1 32 32
    50016091613 Q4205 Membrane graft or wrap sq cm Membrane Wrap BIOLAB SCIENCES INC 1 SQ CM 100 1 100 100
    50016091616 Q4205 Membrane graft or wrap sq cm Membrane Wrap BIOLAB SCIENCES INC 1 SQ CM 64 1 64 64
    50016091617 Q4205 Membrane graft or wrap sq cm Membrane Wrap BIOLAB SCIENCES INC 1 SQ CM 48 1 48 48
    50016091632 Q4205 Membrane graft or wrap sq cm Membrane Wrap BIOLAB SCIENCES INC 1 SQ CM 480 1 480 480
    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