Q4204 – Xwrap, per square centimeter (add-on, list separately in addition to primary procedure)
HCPCS Level II code · Q codes: Temporary Codes
HCPCS codeQ4204
- Long description
- Xwrap, per square centimeter (add-on, list separately in addition to primary procedure)
- Short description
- Xwrap 1 sq cm
- Pricing indicator
11Priced using national RVUs (Physician Fee Schedule)- Medicare coverage
CCarrier judgment – coverage decided by the Medicare contractor- BETOS category
O1EOther drugs- ASC
- Approved for ambulatory surgical centers
- Added
- January 1, 2019
- Last change
- January 1, 2026 – No change
Frequently asked questions
What is HCPCS code Q4204?
Q4204 is a HCPCS Level II code for xwrap, per square centimeter (add-on, list separately in addition to primary procedure).
Does Medicare cover Q4204?
The HCPCS file lists coverage code C: Carrier judgment – coverage decided by the Medicare contractor. Coverage and payment also depend on local coverage determinations and the patient’s plan.
Nearby Q codes
- Q4196 – Puraply am, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4197 – Puraply xt, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4198 – Genesis amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4199 – Cygnus matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4200 – Skin te, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4201 – Matrion, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4202 – Keroxx (2.5g/cc), 1cc
- Q4203 – Derma-gide, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4205 – Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4206 – Fluid flow or fluid gf, 1 cc
- Q4207 – Carbon life, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4208 – Novafix, per square cenitmeter (add-on, list separately in addition to primary procedure)
- Q4209 – Surgraft, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4210 – Axolotl graft or axolotl dualgraft, per square centimeter
- Q4211 – Amnion bio or axobiomembrane, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4212 – Allogen, per cc
Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.