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    HCPCS Details

    HCPC Q4239
    Short Description Amnio-maxx or lite per sq cm
    Long Description Amnio-maxx or amnio-maxx lite, 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 2020-07-01
    Date Added 2020-07-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    AMN23 Q4239 Amnio-maxx or lite per sq cm Amnio-Maxx Royal Biologics 1 SQ CM 6 1 6 6
    AMN44 Q4239 Amnio-maxx or lite per sq cm Amnio-Maxx Royal Biologics 1 SQ CM 16 1 16 16
    AMN46 Q4239 Amnio-maxx or lite per sq cm Amnio-Maxx Royal Biologics 1 SQ CM 24 1 24 24
    AMN48 Q4239 Amnio-maxx or lite per sq cm Amnio-Maxx Royal Biologics 1 SQ CM 32 1 32 32
    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